News | Antiplatelet and Anticoagulation Therapies | December 12, 2017

New Oral Anticoagulant Drugs Associated with Lower Kidney Risks

Mayo Clinic research suggests atrial fibrillation patients must carefully choose anticoagulants with their healthcare provider

New Oral Anticoagulant Drugs Associated with Lower Kidney Risks

December 12, 2017 — Mayo Clinic researchers have shown a link between which type of oral anticoagulant a patient takes to prevent a stroke and increased risks of kidney function decline or failure.

Their study, published online in the Journal of the American College of Cardiology, is the most recent in a series of studies seeking to determine the safety and efficacy of non-vitamin K antagonist oral anticoagulants versus the long-standard warfarin. Patients with atrial fibrillation – a potent risk factor for stroke ─ commonly take these medications.

“Kidney function decline in patients taking oral anticoagulant drugs is an important topic that has been overlooked in previous clinical trials,” said lead author Xiaoxi Yao, Ph.D. “Even our past work at Mayo Clinic has been primarily focused on risks for stroke or bleeding.”

However, she and the study senior author, Peter Noseworthy, M.D., a Mayo Clinic cardiologist, along with the rest of their team, felt that the issue was worth pursuing.

“Our study demonstrated that renal function decline is very common among atrial fibrillation patients on blood thinners,” said Yao. “About 1 in 4 patients had significantly reduced kidney function within two years of being on any of these medications, and 1 in 7 patients had acute kidney injury.”

The reduced kidney function could lead to kidney failure, dialysis and potentially death. Finding this, the researchers went a step further, trying to determine if the type of medication made a difference.

“In general, patients with atrial fibrillation taking blood-thinning medications tend to have declining kidney function over time,” said Noseworthy. “However, our findings indicate that the non-vitamin K antagonist oral anticoagulants as a group are associated with less injury to kidneys than warfarin.”

To come to these conclusions, the researchers studied the deidentified records of 9,769 patients from the OptumLabs Data Warehouse. These patients had atrial fibrillation and started taking oral anticoagulants ─ apixaban, dabigatran, rivaroxaban or warfarin ─ sometime between Oct. 1, 2010, and April 30, 2016.

The team looked at four indicators of kidney function:

  • Thirty percent decline (or more) in glomerular filtration rate (how well the kidneys filter waste);
  • Doubled serum creatinine level (a waste product that should be filtered by the kidneys);
  • Acute kidney injury; and
  • Kidney failure.

They found that the cumulative risk of one of these four events occurring within two years of beginning the medication was 24.4 percent, 4 percent, 14.8 percent and 1.7 percent, respectively, proving that kidney function decline is common in these patients.

However, the researchers took it a step further and separated out the patients taking non-vitamin K antagonist oral anticoagulants from those taking warfarin.

“We found that non-vitamin K antagonist oral anticoagulants, as a group, were associated with reduced risk of adverse kidney outcomes,” said Noseworthy.

“Patients with atrial fibrillation already face a high risk of kidney disease, perhaps because many such patients have risk factors, such as advanced age, diabetes and hypertension,” said Yao. “Many drugs these patients are taking rely on kidney function for drug elimination. Therefore, it is particularly important for these patients to choose a drug that minimizes the impact on kidneys. Since non-vitamin K antagonist oral anticoagulants have a different drug mechanism than warfarin, researchers have hypothesized that non-vitamin K antagonist oral anticoagulants may be related to better renal outcomes. Our study is among the first few studies confirming this hypothesis.”

Their findings have important implications for medical practice, she said, and Noseworthy confirms.

“Just as I do with my own patients, I encourage conversations on these risks and benefits between patients and their providers,” said Noseworthy.“Each patient’s situation is different, so each medication decision must be made based on the individual’s lifestyle and diet, other illnesses and medications, out-of-pocket costs, and so forth.”

Both he and Yao encourage healthcare providers to regularly follow up and monitor kidney function in their patients taking anticoagulants. They urge providers to make efforts to prevent or slow kidney function decline, as well as adjust drug dosage based on the change of kidney function. And, as with all medications, Noseworthy cautions patients to never stop or change any medication dosage without consulting with their healthcare providers.

The rest of the Mayo Clinic research team members are:

  • Bernard Gersh, M.B., Ch.B., D.Phil.;
  • Karl Nath, M.D.;
  • Lindsey Sangaralingham; and
  • Nilay Shah, Ph.D.

The research team also included Navdeep Tangri, M.D., Ph.D., from the University of Manitoba, Canada.

For more information: www.onlinejacc.org

 

Related NOAC Content:

Newer Anticoagulant Reduces Major Bleeds in AF Ablation

Advantages and Disadvantages of Novel Oral Anticoagulants

First Head-to-Head Comparison of Novel Oral Anticoagulants in Matched Population for Costs, Resource Utilization

Related Content

Study Finds Only Six Percent of Patients Taking Statins as Directed
News | Antiplatelet and Anticoagulation Therapies | April 18, 2019
A recent study found patients with atherosclerotic cardiovascular disease cut their risk of a second major adverse...
HonorHealth Research Institute Launches SynIVUS-DAPT Study
News | Antiplatelet and Anticoagulation Therapies | April 16, 2019
HonorHealth Research Institute announced the first patients have been enrolled in the SynIVUS-DAPT Study. The clinical...
Lack of Physician Guidance, Fear of Side Effects Influence Statin Compliance
News | Antiplatelet and Anticoagulation Therapies | April 15, 2019
Despite national guidelines indicating statins can lower risk of heart attack and stroke, many patients who could...
Stopping DAPT After One Month Improved Outcomes in Stent Patients
News | Antiplatelet and Anticoagulation Therapies | March 25, 2019
Patients who stopped taking aspirin one month after receiving a stent in the heart’s arteries but continued taking the...
Apixaban Effective in Specific Cohort of Non-Valvular Atrial Fibrillation Patients
News | Antiplatelet and Anticoagulation Therapies | March 19, 2019
The Bristol-Myers Squibb-Pfizer Alliance announced results from the Phase 4 AUGUSTUS trial evaluating Eliquis (apixaban...
Researchers Develop Reversible, Drug-Free Antiplatelet Therapy
News | Antiplatelet and Anticoagulation Therapies | February 19, 2019
A new reversible, drug-free antiplatelet therapy could reduce the risk of blood clots and potentially prevent cancer...
FDA Approves Portola Pharmaceuticals' Prior Approval Supplement for Andexxa Generation 2 Manufacturing Process
News | Antiplatelet and Anticoagulation Therapies | January 02, 2019
The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals’ Prior Approval Supplement (PAS) for...
Daily Aspirin Use May Do More Harm Than Good for Healthy People
News | Antiplatelet and Anticoagulation Therapies | December 17, 2018
Among otherwise healthy people, a daily dose of aspirin does not save lives and causes additional bleeding, a new...
Experimental Vaccine May Reduce Post-Stroke Blood Clot Risk
News | Antiplatelet and Anticoagulation Therapies | November 01, 2018
A vaccine may one day be able to replace oral blood thinners to reduce the risk of secondary strokes caused by blood...
Overlay Init