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
Researcher
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.

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Anticoagulant Warfarin May Lower Cancer Risk

MedicalResearch.com Interview with:
Gry Haaland, MD

James Lorens PhD, Professor
The Department of Biomedicine
University of Bergen

 MedicalResearch.com: What is the background for this study?

Response: Antitumor activity of the common blood thinner warfarin has been reported in several experimental cancer model systems. We therefore considered whether warfarin is cancer protective.

Using the comprehensive national health registries in Norway, we examined cancer incidence among a large number of people taking warfarin (92,942) and compared to those not taking warfarin (more than 1.1 million).

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Genetic Variants Increase Risk of Intracerebral Hemorrhage in Patients on Warfarin

Christopher D. Anderson, MD, MMSc Neurocritical Care | Acute Stroke Center for Human Genetic Research Massachusetts General Hospital Harvard Medical School Broad Institute of Harvard and MITMedicalResearch.com Interview with:
Christopher D. Anderson, MD, MMSc
Neurocritical Care | Acute Stroke
Center for Human Genetic Research
Massachusetts General Hospital
Harvard Medical School
Broad Institute of Harvard and MIT

Medical Research: What are the main findings of the study?

Dr. Anderson: Previous studies have linked Apolipoprotein E (APOE) epsilon variants with spontaneous intracerebral hemorrhage (ICH) particularly in the lobar (cortical and subcortical) regions of the brain, but it was not known whether this association would extend to warfarin-related ICH, or whether the risk of intracerebral hemorrhage on warfarin would be multiplicatively compounded by APOE epsilon allele status.  Our results demonstrate that APOE e2 and e4 variants are associated with more than a two-fold risk of lobar ICH for patients on warfarin, in comparison to warfarin-exposed individuals without ICH.  This observed association was strongest when analyzing subjects with definite or probable Cerebral Amyloid Angiopathy (CAA), as defined by the Boston Criteria.  No association between APOE e2 or e4 and non-lobar ICH was identified following our replication phase.  Furthermore, we did not detect an interaction between APOE status and warfarin status in ICH subjects using a case-only design.
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Atrial Fibrillation: Risk of Dementia with Non-Therapeutic Levels of Anticoagulation

T. Jared Bunch, MD Medical director for Heart Rhythm Services Director of Heart Rhythm research Intermountain Medical Center, UtahMedicalResearch.com Interview with
T. Jared Bunch, MD
Medical director for Heart Rhythm Services
Director of Heart Rhythm research
Intermountain Medical Center, Utah

MedicalResearch: What are the main findings of the study?

Dr. Bunch: The main findings of the study are:

1) Atrial fibrillation patients treated with warfarin anticoagulation that have lower percentages of time in therapeutic range have significantly higher risks of all forms of dementia.

2) The dementia relative risk related to lower percentages of time in therapeutic range was higher than all other variables associated with stroke or risk of bleeding.

3) The risk of dementia related to lower percentages of time in therapeutic range was highest in younger patients in the study (<80 years).

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Dialysis Patients with Atrial Fibrillation: Warfarin and Risk of Stroke and Bleeding

Louise Pilote, MD, MPH, PhD Department of Medicine, McGill University Department of Epidemiology and Biostatistics, McGill UniversityMedicalResearch.com Interview with:
Louise Pilote, MD, MPH, PhD
Department of Medicine, McGill University
Department of Epidemiology and Biostatistics, McGill University


MedicalResearch.com: What are the main findings of the study?

Dr. Pilote: Our study found that in patients with atrial fibrillation (AF) undergoing dialysis, warfarin use, compared to no-warfarin use, did not reduce the risk for stroke (adjusted hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.78 to 1.67) but it was associated with a 44% higher risk for bleeding event (adjusted HR: 1.44, 95% CI: 1.13 to 1.85). However, warfarin use in non-dialysis patients with AF was associated with a 13% lower risk for stroke (adjusted HR: 0.87, 95% CI: 0.85 to 0.90) and only a 19% higher risk for bleeding event (adjusted HR: 1.19, 95% CI: 1.16 to 1.22).

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Atrial Fibrillation, Warfarin and Kidney Function after Heart Attack

Juan Jesus Carrero PhD (Pharm and Med) Associate Professor in Renal Medicine Karolinska Institutet, Sweden.MedicalResearch.com Interview with:
Juan Jesus Carrero PhD (Pharm and Med)
Associate Professor in Renal Medicine
Karolinska Institutet, Sweden.

 

MedicalResearch.com: Why did you choose to study this particular question?

Answer: We chose this question because there is currently an important knowledge gap regarding safety and effectiveness of common drugs in individuals with chronic kidney disease. Because kidney dysfunction interferes with drug metabolism and drug elimination, patients with kidney dysfunction have traditionally been excluded from randomized controlled trials. Yet, practice guidelines are afterwards extrapolated to those in the absence of formal evaluation.

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Extended Use of Dabigatran, Warfarin, or Placebo in Venous Thromboembolism

 Author Interview: Sam Schulman M.D., FRCPC(C) Professor, Division of Hematology and Thromboembolism, Department of Medicine Associate Professor, Medicine, Karolinska Institute, Stockholm, Sweden Director, Clinical Thromboembolism Program Hamilton Health Sciences, Hamilton General Hospital, Hamilton, OntarioMedicalResearch.com  Author Interview: Sam Schulman M.D., FRCPC(C)
Professor, Division of Hematology and Thromboembolism, Department of Medicine
Associate Professor, Medicine, Karolinska Institute, Stockholm, Sweden
Director, Clinical Thromboembolism Program Hamilton Health Sciences, Hamilton General Hospital, Hamilton, Ontario

MedicalResearch.com: What are the main findings of the study?

Response: Similar effect of dabigatran  as warfarin, 92% risk reduction compared to placebo. The risk of bleeding is reduced by almost 50% compared to warfarin but in comparison with placebo there is an increased risk of minor bleeding. No routine coagulation monitoring or dose adjustments are required, making the treatment convenient for patients and physicians.
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