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Abstract: FR-PO230

Direct Oral Anticoagulants vs Warfarin Across CKD Stages: Mortality Outcomes in US Veterans

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Dratch, Alissa, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Edgett, Drake Anthony, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Tantisattamo, Ekamol, University of California, Irvine School of Medicine, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Lau, Wei Ling, University of California, Irvine School of Medicine, Orange, California, United States
Background

For over 50 years warfarin was the only oral anticoagulant available and was shown to prevent stroke and improve survival in the general population. However, evidence to support use of anticoagulation in patients with advanced CKD has been controversial. Direct Oral Anticoagulants (DOACs) became available in the past decade but outcomes data in CKD is limited. In this project we examined mortality outcomes associated with DOACs vs. warfarin therapy in the Veterans Affairs (VA) database.

Methods

In a national cohort of US veterans, we identified patients who were initiated on warfarin or DOAC treatment between 1/1/2012-12/31/2013. Cox models were used to calculate mortality hazard ratios across stages of kidney disease (or no kidney disease) with multivariable adjustment for age, gender, race and baseline comorbidities (diabetes, hypertension, heart failure, myocardial infarction, prior stroke, antiplatelet medications).

Results

The cohort included 27,787 patients of which 73% were non-CKD, 15% were CKD stage 3a, 5% were CKD stage 3b, and 1% were CKD stage 4. There were no CKD stage 5 patients on DOACs. Patients had a mean±SD age of 69±10 years and included 19% diabetics, 15% African-Americans and 2% Hispanics. Patients on warfarin were more likely to be older, African-American, and have pre-existing comorbidities. Compared to warfarin, patients initiated on DOAC medication had a lower risk of death in non-CKD and CKD stage 3a groups; however associations were attenuated and trended toward a reverse association in later stage CKD [Figure].

Conclusion

In a national cohort of US veterans DOACs were associated with a lower mortality risk in non-CKD and early stage CKD. Further studies with larger patient numbers are warranted to evaluate outcomes of DOACs vs. warfarin therapy in later stage CKD.

Funding

  • Veterans Affairs Support