School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia.
Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, Launceston, Tasmania, Australia.
Expert Rev Clin Pharmacol. 2022 Mar;15(3):359-364. doi: 10.1080/17512433.2022.2070151. Epub 2022 May 1.
We aimed to compare renal function changes in patients with atrial fibrillation (AF) prescribed different oral anticoagulants (OACs).
We performed a retrospective analysis of Australian national primary care data. A total of 12,562 patients with AF and initiated OAC between 1 January 2013 and 31 December 2017 were included. Inverse probability of treatment weighting was used for balancing baseline characteristics and the risks of decline in estimated glomerular filtration rate (eGFR) in patients prescribed each OAC were compared.
Compared with warfarin, prescribing of direct-acting oral anticoagulants (DOACs) was associated with a lower risk of renal function decline per 1000 person-years: hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.68-0.81, p < 0.001 for ≥30% decline in eGFR; HR 0.28, 95% CI 0.20-0.41, p < 0.001 for eGFR decline to ≤30 mL/min/1.73 m; and HR 0.45, 95% CI 0.35-0.58, p < 0.001 for serum creatinine doubling. Compared with dabigatran, rivaroxaban use had a significantly lowered risk of decline in eGFR to ≤30 mL/min/1.73 m (HR 0.29, 95% CI 0.13-0.66, p = 0.003) and risk of doubling of serum creatinine (HR 0.62, 95% CI 0.40-0.95, p = 0.030).
The risk of renal function decline appeared to be lower in patients prescribed DOACs versus warfarin.
我们旨在比较服用不同口服抗凝剂（OAC）的心房颤动（AF）患者的肾功能变化。
我们对澳大利亚国家初级保健数据进行了回顾性分析。共纳入 12562 例 2013 年 1 月 1 日至 2017 年 12 月 31 日期间开始服用 OAC 的 AF 患者。采用逆概率治疗加权法平衡了患者基线特征，并比较了服用每种 OAC 患者估算肾小球滤过率（eGFR）下降的风险。
与华法林相比，直接口服抗凝剂（DOAC）的处方与肾功能下降的风险降低相关：eGFR 下降≥30%的风险比（HR）为 0.75，95%置信区间（CI）为 0.68-0.81，p<0.001；eGFR 下降至≤30 mL/min/1.73 m 的 HR 为 0.28，95%CI 为 0.20-0.41，p<0.001；血清肌酐倍增的 HR 为 0.45，95%CI 为 0.35-0.58，p<0.001。与达比加群相比，利伐沙班使用的 eGFR 下降至≤30 mL/min/1.73 m 的风险显著降低（HR 0.29，95%CI 0.13-0.66，p=0.003），且血清肌酐倍增的风险降低（HR 0.62，95%CI 0.40-0.95，p=0.030）。
与华法林相比，服用 DOAC 的患者肾功能下降的风险似乎较低。
