Anticoagulation in Patients with Chronic Kidney Disease: DOACs Assessed

Chronic kidney disease (CKD; creatinine clearance, 20–60 mL/minute) and end-stage renal disease (ESRD; creatinine clearance, <20 mL/minute) are prothrombotic states, yet in large trials of newer anticoagulants, CKD and ESRD patients often are excluded. Investigators performed meta-analyses of 45 randomized trials that included 34,000 patients with CKD or ESRD to assess the efficacy and safety of direct-acting oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) for managing atrial fibrillation or venous thromboembolism (VTE).

In patients with CKD and atrial fibrillation, DOACs significantly lowered the incidence of stroke or systemic embolism compared with VKAs (4% vs. 5%; number needed to treat, 100) or aspirin (2% vs. 6%;…