Table 2.
Study (n) | Agents | Design features | Exclusion criteria related to CKD | Dose adjustment related to CKD | Stage 3 CKD (%) | Mean time in therapeutic range (INR 2– 3) | Main results |
---|---|---|---|---|---|---|---|
RE-LY68 | Dabigat ran 150 mg or 110 mg twice daily vs. warfarin | Warfarin given open- label | eCrCl<30 ml/min | None | 10% eCrCl 30–49 ml/min | 64% | Stroke, non-CNS embolism and cardiovascular mortality reduced by dabigatran 150 mg vs. warfarin; major haemorrhage reduced by dabigatran 110 mg vs. warfarin; intracranial bleeding reduced by both doses of dabigatran vs. warfarin; no significant differences in total mortality |
AVERROES67 (5,599) | Apixaban 5 mg twice daily vs. aspirin | Double- blind; restricted to those deemed unsuitable for warfarin | Serum creatinine >221 umol/L or eCrCr<25 ml/min | 2.5 mg twice daily if serum creatinine ≥ 133 umol/L plus age ≥ 80 years or weight ≤60 kg | 30% eCrCl 30–59 ml/min | NA | Stroke and non-CNS embolism reduced by apixaban vs aspirin; major haemorrhage and intracranial bleeding comparable with both agents; no significant difference in cardiovascular or total mortality |
ROCKET AF69 (14, 264) | Rivaroxaban 20 mg per day vs. warfarin | Double- blind; restricted to those at high risk of stroke | eCrCl<30 ml/min | 15 mg per day if CrCl<50 ml/min | 21% eCrCl 30–49 ml/min | 55% | Rivaroxaban noninferior to warfarin for stroke and non-CNS embolism; major haemorrhage comparable with both agents; intracranial bleeding reduced by rivaroxaban vs. warfarin; no significant difference in cardiovascular or total mortality |
ARISTOTLE55 | Apixaban 5 mg twice daily vs. warfarin | Double- blind | Serum creatinine >221 umol/L or eCrCl<25 ml/min | 2.5 mg twice daily if serum creatinine ≥ 133 umol/L plus age ≥ 80 years or weight ≤ 60 kg | 15% eCrCl 30–50 ml/min | 62% | Stroke, non-CNS embolism, major haemorrhage, intracranial bleeding and total mortality reduced by apixaban vs. warfarin; no significant difference in cardiovascular mortality |
Abbreviations: CKD=chronic kidney disease; CNS=central nervous system; eCrCl=estimated creatinine clearance; INR=international normalized ratio; NA=not available
Hart, R. G. (2012) Anticoagulants in atrial fibrillation patients with chronic kidney disease et al. Nat. Rev. Nephrol. doi:10.1038/nrneph.2012.160