title: Comparison of non-vitamin K antagonist oral anticoagulants and warfarin on clinical outcomes in atrial fibrillation patients with renal dysfunction.
abstract: OBJECTIVE
  We aimed to compare the efficacy and safety between non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in atrial fibrillation (AF) patients according to renal dysfunction.
  
  
  RESULTS
  We analysed 1319 patients who had been taken oral anticoagulants. They were classified into patients taking NOACs (n = 326) and warfarin (n = 993). Renal dysfunction was defined as the estimated glomerular filtration rate <60 mL/min by using the Chronic Kidney Disease Epidemiology Collaboration equation. The composite clinical outcomes were defined as the composite of death, hospitalization, and new-onset strokes. Safety outcomes were composed of major and minor bleeding. Subgroup analyses for clinical and safety outcomes were performed according to renal dysfunction during median 596 (506-612) follow-up days. The prevalence of renal dysfunction was similar between the two groups. The incidences of death, hospitalization, and strokes were not different between the two groups. However, the incidences of major bleeding was significantly higher in patients taking warfarin. In the subgroup analysis with renal dysfunction, the use of NOACs significantly improved the composite clinical outcomes (adjusted hazard ratio, HR, 0.30, 95% confidence interval, CI, 0.11-0.77, interaction P = 0.018) and major bleeding (adjusted HR 0.18, 95% CI 0.07-0.45, interaction P = 0.199) even after the covariate adjustment. However, in patients without renal dysfunction, there were no differences in the incidences of the composite clinical outcomes between the two groups.
  
  
  CONCLUSIONS
  The benefit of NOACs was more prominent in AF patients with renal dysfunction than without renal dysfunction. These results suggest that NOACs as the first choice oral anticoagulant in AF patients with renal dysfunction.
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Ki Hong
authors: KH
authors: Lee
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea mdhwp@chol.com.
authors: Hyung Wook
authors: HW
authors: Park
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Jeong Gwan
authors: JG
authors: Cho
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Nam Sik
authors: NS
authors: Yoon
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Sung Soo
authors: SS
authors: Kim
authors: Chunnam Techno University, Chonnam, South Korea.
authors: Mi Ran
authors: MR
authors: Kim
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Min Chul
authors: MC
authors: Kim
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Kyung Hoon
authors: KH
authors: Cho
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Hyun Kuk
authors: HK
authors: Kim
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Cheol Hwan
authors: CH
authors: Kim
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Kyung Hwan
authors: KH
authors: Kim
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Seung Jin
authors: SJ
authors: Jun
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Woo Jin
authors: WJ
authors: Kim
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Kyoung Jin
authors: KJ
authors: Lee
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Hae Chang
authors: HC
authors: Jeong
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Jae Yeong
authors: JY
authors: Cho
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Keun-Ho
authors: KH
authors: Park
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Doo sun
authors: Ds
authors: Sim
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Hyun Ju
authors: HJ
authors: Yoon
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Kye Hun
authors: KH
authors: Kim
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Young Joon
authors: YJ
authors: Hong
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Ju Han
authors: JH
authors: Kim
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Youngkeun
authors: Y
authors: Ahn
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Myung Ho
authors: MH
authors: Jeong
authors: The Heart Center of Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju 501-757, South Korea.
authors: Jong Chun
authors: JC
authors: Park
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality*; D008297:Male; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality* / Q000517:prevention & control*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin
keywords: Anticoagulation; Atrial fibrillation; Chronic kidney disease; Prognosis; Safety; Warfarin