Impact of increased kidney function on clinical and biological outcomes in real-world patients treated with Direct Oral Anticoagulants
Background and purpose Renal excretion of direct oral anticoagulants (DOACs) varies depending on the drug. Hypothetically, an increased glomerular filtration rate (GFR) may lead to suboptimal dosing and a higher thromboembolic events incidence. However, real-world patient data do not support the the...
| Autores: | , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2022 |
| País: | España |
| Institución: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p15722 |
| Acceso en línea: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=15722 https://ddd.uab.cat/record/277678 |
| Access Level: | acceso abierto |
| Palabra clave: | apixaban dabigatran edoxaban rivaroxaban anticoagulant agent blood clotting factor 10a inhibitor dipyrone low molecular weight heparin aged anticoagulation Article atrial fibrillation biological activity clinical feature clinical practice comparative study controlled study drug blood level drug use female follow up glomerulus filtration rate human incidence kidney function major clinical study male observational study patient registry prospective study thrombin time treatment outcome venous thromboembolism kidney oral drug administration Administration, Oral Anticoagulants Atrial Fibrillation Dabigatran Factor Xa Inhibitors Heparin, Low-Molecular-Weight Humans Kidney Prospective Studies Pyridones Rivaroxaban |
| Sumario: | Background and purpose Renal excretion of direct oral anticoagulants (DOACs) varies depending on the drug. Hypothetically, an increased glomerular filtration rate (GFR) may lead to suboptimal dosing and a higher thromboembolic events incidence. However, real-world patient data do not support the theoretical risk. The aim is to analyse DOAC outcomes in patients with normal and high (=90 mL/min) GFR, focusing on biological parameters and thrombotic/haemorrhagic events. Methods Observational prospective single-centre study and registry of patients on DOACs. Followup was 1,343 patient-years. A bivariate analysis was performed of baseline variables according to GFR (<90 mL/min vs =90 mL/min). Anti-Xa activity before and after drug intake (HemosIL, Liquid Anti-Xa, Werfen) was measured for edoxaban, apixaban, and rivaroxaban; diluted thrombin time for dabigatran (HEMOCLOT); and additionally, plasma concentrations in edoxaban (HemosIl, Liquid Anti-Xa suitably calibrated). Results 1,135 patients anticoagulated with DOACs were included and 152 patients with GFR =90 mL/min. Of 18 serious thrombotic complications during follow-up, 17 occurred in patients with GFR <90 mL/min, and 1 in a patient with GFR =90 mL/min. A higher incidence of complications was observed in patients with normal GFR, but the difference was not statistically significant (p>0.05). No statistically significant differences with clinical relevance were observed between the normal or supranormal groups in anti-Xa activity or in edoxaban plasma concentrations. Conclusions There was no increased incidence of thrombotic/haemorrhagic complications in our patients treated with DOACs, including 66% treated with edoxaban, and patients with GFR =90 mL/ min. Likewise, drug anti-Xa activity and edoxaban plasma concentration did not seem to be influenced by GFR. © 2022 Corrochano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
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