Evidence Favors NOACs for Anticoagulation in Early Chronic Kidney Disease

By Joe Elia

Edited by David G. Fairchild, MD, MPH

In early-stage chronic kidney disease, non-vitamin K oral anticoagulants (NOACs) seem beneficial to prevent stroke or thromboembolism. For patients with advanced disease, the benefits aren't clear.

Reporting in the Annals of Internal Medicine, researchers examined evidence from 45 randomized trials testing oral anticoagulation strategies in 34,000 patients with either chronic or dialysis-dependent renal disease.

They found NOACs superior to vitamin K antagonists for preventing stroke and systemic embolism in patients with atrial fibrillation and early-stage disease. In patients with advanced or end-stage disease, however, the authors found insufficient evidence to recommend wide use of either class of anticoagulants to improve outcomes.

Editorialists point to two ongoing trials that should provide further guidance. Until those results are available, they write, "the decision to use anticoagulant therapy in patients with [end-stage disease] will continue to require an individualized approach that balances potential benefits and harms."