NOACs For Atrial Fib Anticoagulation May Have Lower Risk of Kidney Side Effects

Atrial Fibrillation - Wikipedia image

Normal rhythm tracing (top) Atrial fibrillation (bottom) Wikipedia

Interview with:
Dr Xiaoxi Yao PhD
Assistant Professor
Mayo Clinic

What is the background for this study? What are the main findings?

Response: Lifelong oral anticoagulation, either with warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC), is indicated for stroke prevention in most patients with atrial fibrillation (AF). Emerging evidence suggests that NOACs may be associated with better renal outcomes than warfarin.

The study found renal function decline is common among patients with atrial fibrillation treated with oral anticoagulants. NOACs, particularly dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin. What should readers take away from your report?

  • Regularly monitor renal function: Patients with atrial fibrillation face a high risk of kidney disease, and many atrial fibrillation patients have other risk factors that promote kidney function decline, such as advanced age, diabetes and hypertension.

    Physicians should regularly monitor renal function, make efforts to prevent and slow renal function decline, and adjust drug dosage according to renal function. For example, all NOACs rely on kidney for drug elimination, and they may require dose reduction when the kidney function decline to a certain extent.

  •  Consider the potential renal benefits of NOACs: Because many drugs these patients are taking depend on kidney for drug elimination, and worse renal function further increases patients’ risk of both stroke and bleeding, it is very important to choose a drug that minimizes the impact on kidneys. When choosing which oral anticoagulants to use, the potential renal benefits of NOACs may need to be taken into consideration What recommendations do you have for future research as a result of this study?

Response: Our study is an observational study, and future randomized trials are needed to confirm our findings. Is there anything else you would like to add?

Response: For some patients, NOAC may have a higher cost than warfarin, and the high cost could be a barrier to long-term adherence. Physicians should discuss the risk, benefit and cost with patients, and together make a decision most suitable for an individual patient. Thank you for your contribution to the community.


Journal of the American College of Cardiology
Volume 70, Issue 21, November 2017DOI: 10.1016/j.jacc.2017.09.1087
Renal Outcomes in Anticoagulated Patients With Atrial Fibrillation
Xiaoxi Yao, Navdeep Tangri, Bernard J. Gersh, Lindsey R. Sangaralingham, Nilay D. Shah, Karl A. Nath and Peter A. Noseworthy

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. 

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