Efficacy and Safety of Direct Oral Anticoagulants for Patients With Atrial Fibrillation With Glomerular Hyperfiltration: A Systematic Review and Meta-Analysis

The purpose of this study was to identify possible therapeutic benefits of direct oral anticoagulants (DOACs) compared with warfarin in subjects with supranormal renal function. PubMed and Embase were systematically searched until September 25, 2022. Articles that met the prespecified selection crit...

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Veröffentlicht in:Clinical therapeutics Jg. 47; H. 9; S. 798 - 806
Hauptverfasser: Gao, Xinyi, Jia, Ziheng, Tse, Gary, Lip, Gregory Y.H., Liu, Tong
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.09.2025
Elsevier Limited
Schlagworte:
Administration, Oral
Anticoagulants
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Cardiac arrhythmia
Cohort analysis
Collaboration
Creatinine
Direct oral anticoagulants
Drug efficacy
Embolism
Factor Xa Inhibitors - administration & dosage
Factor Xa Inhibitors - adverse effects
Fibrillation
Glomerular Filtration Rate
Glomerular hyperfiltration
Hemorrhage
Hemorrhage - chemically induced
Hemorrhage - epidemiology
Humans
Internal Medicine
Kidney diseases
Meta-analysis
Nonvalvular atrial fibrillation
Pharmacovigilance
Renal function
Stroke
Stroke - etiology
Stroke - prevention & control
Supranormal renal function
Systematic review
Thromboembolism
Treatment Outcome
Warfarin
Warfarin - administration & dosage
Warfarin - adverse effects
Warfarin - therapeutic use
Warfarin
Direct oral anticoagulants
Supranormal renal function
Nonvalvular atrial fibrillation
Glomerular hyperfiltration
ISSN:0149-2918, 1879-114X, 1879-114X
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Zusammenfassung:The purpose of this study was to identify possible therapeutic benefits of direct oral anticoagulants (DOACs) compared with warfarin in subjects with supranormal renal function. PubMed and Embase were systematically searched until September 25, 2022. Articles that met the prespecified selection criteria were included. The fixed-effects model was chosen if there is no significant heterogeneity. Subgroup analyses were conducted to find the sources of heterogeneity. Variables that might expand heterogeneity were selected as follows: (1) type of DOAC, (2) dose of DOAC, (3) equation for glomerular filtration rate estimation, and (4) types of original research. A total of 7 studies involving 87,514 patients were included. In patients with creatinine clearance (CrCl) >80 mL/min, DOACs were associated with a significant reduction in the overall effectiveness outcomes compared with warfarin (hazard ratio [HR] = 0.75; 95% CI, 0.66–0.86; P < 0.0001; I2 = 66%), but not for stroke/systematic embolism (HR = 0.90; 95% CI, 0.72–1.14; P = 0.40; I2 = 17%). Similarly, DOACs showed a decreased risk of safety outcomes compared with warfarin (HR = 0.68; 95% CI, 0.63–0.74; P < 0.0001; I2 = 45%). In patients with CrCl >95 mL/min, DOACs were associated with a borderline lower risk of effectiveness outcomes (HR = 0.83; 95% CI, 0.68–1.01; P = 0.07; I2 = 61%) and significantly lower risk of safety outcomes (HR = 0.66; 95% CI, 0.58–0.76; P < 0.0001; I2 = 0%), particularly major bleeding (HR = 0.63; 95% CI, 0.53–0.76; P < 0.0001; I2 = 0%) and intracranial hemorrhage (HR = 0.43; 95% CI, 0.30–0.62; P < 0.0001; I2 = 0%). In patients with atrial fibrillation and CrCl >80 mL/min, DOACs have greater clinical benefits than warfarin. For those with atrial fibrillation and CrCl >95 mL/min, significantly better safety outcomes were observed for DOACs.
Bibliographie:ObjectType-Article-2
SourceType-Scholarly Journals-1
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ObjectType-Feature-3
ObjectType-Evidence Based Healthcare-1
ObjectType-Article-1
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ISSN:0149-2918
1879-114X
1879-114X
DOI:10.1016/j.clinthera.2025.06.015