Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 65, Issue 23, Pages 2481-2493Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2015.03.577
Keywords
anticoagulation; atrial fibrillation; renal function; thrombin inhibition; vitamin K antagonist
Categories
Funding
- Boehringer Ingelheim, Germany
- Boehringer Ingelheim
- Deutsche Forschungsgesellschaft [KFO 196]
- Bayer
- Servier
- Medtronic
- Pfizer
- Sanofi
- Bristol-Myers Squibb
- Portola
- Daiichi-Sankyo
- Aegerion
- Merck
- Johnson Johnson
- Gilead
- Janssen Scientific Affairs
- Pozen Inc.
- Amgen
- Coherex
- Armetheon
- AstraZeneca
- Bristol-Myers Squibb/Pfizer
- Eli Lilly
- St. Jude Medical
- Zoll
- GlaxoSmithKline
- Merck Co.
- Abbott
- Athera Biotechnologies
- Regado Biosciences
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BACKGROUND Vitamin K-dependent factors protect against vascular and renovascular calcification, and vitamin K antagonists may be associated with a decreased glomerular filtration rate (GFR). OBJECTIVES This study analyzed changes in GFR during long-term treatment with warfarin or dabigatran etexilate (DE) in patients enrolled in the RE-LY (Randomized Evaluation of Long Term Anticoagulation Therapy) trial. METHODS Of the 18,113 patients in the RE-LY study randomized to receive DE (110 mg or 150 mg twice daily) or warfarin, 16,490 patients with atrial fibrillation had creatinine values measured at baseline and at least 1 follow-up visit. Changes in GFR for up to 30 months were evaluated. RESULTS GFR declined in all treatment groups. After an average of 30 months, the mean +/- SE decline in GFR was significantly greater with warfarin (-3.68 +/- 0.24 ml/min) compared with DE 110 mg (-2.57 +/- 0.24 ml/min; p = 0.0009 vs. warfarin) and DE 150 mg (-2.46 +/- 0.23 ml/min; p = 0.0002 vs. warfarin). A decrease in GFR >25% was less likely with DE 110 mg (hazard ratio: 0.81 [95% confidence interval: 0.69 to 0.96]; p = 0.017) or DE 150 mg (hazard ratio: 0.79 [95% confidence interval: 0.68 to 0.93]; p = 0.0056) than with warfarin in the observation period >18 months. Patients with poor international normalized ratio control (i.e., time in therapeutic range <65%) exhibited a faster decline in GFR. A more pronounced decline in GFR was associated with previous warfarin use and with the presence of diabetes. CONCLUSIONS Patients with atrial fibrillation receiving oral anticoagulation exhibited a decline in renal function that was greater in those taking warfarin versus DE, and it was amplified by diabetes and previous vitamin K antagonist use. (C) 2015 by the American College of Cardiology Foundation.
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