Chan, Yi-Hsin, Chao, Tze-Fan, Lee, Hsin-Fu, Yeh, Yung-Hsin, Chang, Shang-Hung, Kuo, Chi-Tai, Lip, Gregory YH 
ORCID: 0000-0002-7566-1626 and Chen, Shih-Ann
(2022)
Different Renal Function Equations and Dosing of Direct Oral Anticoagulants in Atrial Fibrillation.
JACC. Asia, 2 (1).
pp. 46-58.
|
PDF
Different Renal Function Equations and Dosing of Direct Oral Anticoagulants in Atrial Fibrillation.pdf - Open Access published version Download (3MB) | Preview |
Abstract
<h4>Background</h4>Randomized trials of direct oral anticoagulants (DOACs) adopted the Cockcroft-Gault (CG) formula to calculate estimated glomerular filtration rate (eGFR) to determine the dosages of DOACs.<h4>Objectives</h4>The authors aimed to investigate the agreements/disagreements of eGFRs calculated using different equations (CG, Modified Diet in Renal Disease [MDRD], and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formulas), and their impacts on the dosages of DOACs and clinical outcomes.<h4>Methods</h4>Medical data from a multicenter health care provider in Taiwan including 39,239 patients with atrial fibrillation were used. Among these patients, there were 11,185 and 2,323 patients treated with DOACs and warfarin, respectively.<h4>Results</h4>At the cutoff values of eGFR of <15, 15-50, and >50 mL/min, the agreements were 78% between MDRD and CG and 81% between CKD-EPI and CG. The disagreements among the different equations were largely due to overestimations, especially for patients aged >75 years and with a body weight of <50 kg (58.8% for MDRD and 50.9% for CKD-EPI). Among patients receiving DOACs whose dosages were defined as "on label" based on MDRD or CKD-EPI, only those whose dosages were "truly on label" based on CG were associated with a lower risk of major bleeding (adjusted HR: 0.34; 95% CI: 0.26-0.45) compared to warfarin.<h4>Conclusions</h4>The adoptions of MDRD or CKD-EPI rather than CG would result in inappropriate dosing of DOACs (mainly overdosing), which would attenuate the advantages of DOACs compared to warfarin. The CG equation should be used as the gold standard to calculate eGFRs and guide the DOAC dosages.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | AF, atrial fibrillation, BW, body weight, CG formula, Cockcroft-Gault formula, CGMH, Chang Gung Memorial Hospital, CKD-EPI, CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration, Cockcroft-Gault (CG) formula, DOAC, direct oral anticoagulant, ICD-10-CM, International Classification of Diseases-10th Revision-Clinical Modification, ICD-9-CM, International Classification of Diseases-9th Revision-Clinical Modification, IS/SE, ischemic stroke/systemic embolism, MDRD, MDRD, Modified Diet in Renal Disease, aHR, adjusted HR, atrial fibrillation, eGFR, estimated glomerular filtration rate, eGFRs, sCr, serum creatinine |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 29 Sep 2023 14:03 |
| Last Modified: | 29 Sep 2023 14:03 |
| DOI: | 10.1016/j.jacasi.2021.11.006 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173230 |
Dimensions
Dimensions
