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Kidney Week

Abstract: SA-PO790

Risks and Benefits of Novel Oral Anticoagulants across the Spectrum of CKD among Patients with Atrial Fibrillation

Session Information

Category: Patient Safety

  • 1501 Patient Safety


  • Shin, Jung-Im, Johns Hopkins University, Baltimore, Maryland, United States
  • Secora, Alex, Johns Hopkins University, Baltimore, Maryland, United States
  • Coresh, Josef, Johns Hopkins University, Baltimore, Maryland, United States
  • Chang, Alex R., Geisinger Medical Center, Danville, Pennsylvania, United States
  • Grams, Morgan, Johns Hopkins University, Baltimore, Maryland, United States

The relative safety of novel oral anticoagulants (NOACs) vs. warfarin for treatment of atrial fibrillation (AF) in patients with chronic kidney disease (CKD) in real-world settings is unknown. The objective of the study was to evaluate risks and benefits of NOACs in comparison with warfarin across a range of estimated glomerular filtration rate (eGFR).


We analyzed a cohort of 3,206 patients with AF who used NOACs (Apixaban, Rivaroxaban, or Dabigatran) and a 1:1 propensity-score matched cohort of 3,206 warfarin users between October 2010 and January 2017 in the Geisinger Health System. We estimated the incidence rates of bleeding and ischemic stroke, stratified by G-stage of CKD.


Mean baseline age of the study population was 73.3 years, 46.6% were women, and mean eGFR was 68.5 ml/min/1.73 m2. There were 1,181 bleeding events, 466 ischemic strokes, and 310 deaths among 6,412 patients with 7,391 person-years (PYs) of follow-up. The incidence rates of bleeding (NOACs vs. warfarin) were 17.4 vs. 16.9 per 100 PYs among those with eGFR≥60, 25.2 vs. 19.0 among those with eGFR 30-59, and 38.1 vs. 30.4 for eGFR<30 ml/min/1.73 m2, respectively (Figure 1). The incidence rates of ischemic stroke were 6.0 vs. 6.0, 8.8 vs. 7.5, and 9.2 vs. 10.6 for those with eGFR≥60, eGFR 30-59, and eGFR<30 ml/min/1.73 m2, respectively. Similar findings were observed when each drug was analyzed individually. Among the 122 NOACs users with eGFR<30, 27.8% were not prescribed with renal dose adjustment.


In real-world settings, patients with CKD on NOACs for treatment of AF appeared to experience bleeding events more frequently than those on warfarin. Further large-scale studies are warranted to confirm our descriptive findings.