Novel Oral Anticoagulants in Patients with Renal Insufficiency:A Meta-Analysis of Randomized Trials

The Canadian journal of cardiology (Impact Factor: 3.94). 08/2014; 30(8). DOI: 10.1016/j.cjca.2014.04.015


Recent reports suggest altered antithrombotic efficacy and higher risk of bleeding with new oral anticoagulants (NOAC) in patients with renal insufficiency. A meta-analysis was performed to evaluate the efficacy and safety with recommended doses of NOAC compared to conventional treatment in patients with renal insufficiency.

PubMed, Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases were searched from January 01, 2001 through March 23, 2014. Randomized controlled trials (RCTs) comparing NOACs (rivaroxaban apixaban, and dabigatran) with comparators (vitamin K antagonist/warfarin, low molecular weight heparin, aspirin, placebo) were selected.

There were 40,693 patients with renal insufficiency in ten trials. Compared to other anticoagulants in patients with mild renal insufficiency there was significantly less major or clinically relevant non-major (CRNM) bleeding (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.72- 0.90) and stroke or systemic embolism (OR 0.70, 95% CI 0.54- 0.92), with NOACs. By random effects meta-analysis, there was significantly less stroke or systemic embolism (OR 0.72, 95% CI 0.57- 0.92) and a trend toward less major or CRNM bleeding (OR 0.82, 95% CI 0.59- 1.14) with the NOACs among patients with moderate renal insufficiency, and this became statistically significant when evaluated using a fixed effects model. NOACs showed efficiency comparable to conventional anticoagulants for prevention of venous thromboembolism (VTE) or related mortality.

In patients with renal insufficiency, recommended doses of novel anticoagulants are noninferior and relatively safe compared to conventional anticoagulants.

53 Reads
  • The Canadian journal of cardiology 08/2014; 30(8). DOI:10.1016/j.cjca.2014.06.006 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In Europa leiden über 6 Mio. Menschen an Vorhofflimmern. Es wird geschätzt, dass sich die Prävalenz in den nächsten 50 Jahren verdoppeln wird. Das Hauptziel bei der Behandlung von Vorhofflimmern ist es, thrombembolische Komplikationen zu verhindern. Erreicht wird das durch den Einsatz oraler Antikoagulanzien, deren Auswahl sich am Risikoprofil (mithilfe von Risikoscores wie dem CHA2DS2-VASc-Score) und an den Komorbiditäten orientiert. Die weitere Behandlung ist symptomorientiert. Eine Frequenzkontrolle < 110/min in Ruhe scheint ausreichend zu sein. Bei hohem Leidensdruck wird eine rhythmuserhaltende Strategie mittels Kardioversion, Antiarrhythmika und Katheterablation verfolgt. Die Katheterablation von Vorhofflimmern hat zunehmenden Stellenwert und kann Erstlinientherapie sein. Inwieweit der Erhalt des Sinusrhythmus die Prognose von Vorhofflimmern beeinflusst, ist aktuell Gegenstand intensiver Forschung.
    Der Kardiologe 10/2014; 8(5):374-384. DOI:10.1007/s12181-014-0613-9
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Venous thromboembolism (VTE) is a major cause of morbidity, mortality, and healthcare expenditure. In the United States, approximately 0.1 % of the population experiences an initial VTE event each year. Anticoagulation therapy is the cornerstone of acute VTE treatment and for prevention of recurrent VTE events. Conventional anticoagulants, including heparin, low-molecular-weight heparins, fondaparinux, and vitamin K antagonists are widely used but have limitations. Newer oral anticoagulant agents, including direct thrombin inhibitors (e.g., dabigatran etexilate) and direct factor Xa inhibitors (e.g., rivaroxaban, apixaban, and edoxaban) have been developed to attempt to overcome some of the limitations of conventional anticoagulant therapy. These new oral agents have been evaluated for safety and efficacy in large, randomized clinical trials in the treatment and secondary prevention of VTE with results that are comparable to conventional therapy. Dabigatran, rivaroxaban, apixaban, and edoxaban are important new treatment options for patients with VTE. In this review, we compare these new agents and their associated clinical trials in VTE treatment.
    Drugs 10/2014; 74(17). DOI:10.1007/s40265-014-0301-x · 4.34 Impact Factor
Show more