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June 7, 2026Open Access

The Renal Impact of Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients with Atrial Fibrillation: A Systematic Review and Meta-analysis

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Why the study?

Do direct oral anticoagulants (DOACs) reduce the risk of renal function deterioration compared to Vitamin K antagonists (VKAs) in patients with atrial fibrillation?

Population

13 studies pooling 302,071 patients with atrial fibrillation

Comparison

Direct oral anticoagulants as a class vs Vitamin K antagonists (VKAs)

Design

Meta-analysis

Follow-up

mean 2.3 years per patient

Authors

ΑΑΑναστασία Θ. Αδάμου

Discussion

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Overview

In patients with atrial fibrillation, the use of DOACs is associated with a significantly delayed deterioration of renal function compared to vitamin K antagonists.

Key Points

  • To assess the comparative effects of direct oral anticoagulants and vitamin K antagonists on renal function in patients with atrial fibrillation.
  • Systematic review and meta-analysis following PRISMA guidelines
  • Comprehensive search in PubMed/MEDLINE and EMBASE
  • Included studies assessing renal function outcomes in AF patients on DOACs or VKAs.
  • DOACs associated with lower risk of 30% eGFR reduction (HR:0.72, 95%CI:0.59–0.88)
  • Lower risk of progression to stage five CKD (HR:0.49, 95%CI:0.37–0.64)
  • Lower risk of doubling serum creatinine (HR:0.50, 95%CI:0.42–0.61).

Structured PICO

Do direct oral anticoagulants (DOACs) reduce the risk of renal function deterioration compared to Vitamin K antagonists (VKAs) in patients with atrial fibrillation?

P
Population
13 studies pooling 302,071 patients with atrial fibrillation
I
Intervention
Direct oral anticoagulants (DOACs) as a class (including apixaban, dabigatran, and rivaroxaban)
C
Comparator
Vitamin K antagonists (VKAs)
O
Outcome
30% estimated glomerular filtration rate (eGFR) decline, progression to stage five chronic kidney disease (CKD) and doubling of serum creatininesurrogate

In patients with atrial fibrillation, the use of DOACs is associated with a significantly delayed deterioration of renal function compared to vitamin K antagonists.

Cite This Study

Αναστασία Θ. Αδάμου (2026) studied this question.

synapsesocial.com/papers/6a250be87def13d035e1be18https://doi.org/10.26262/heal.auth.ir.373661
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Efficacy and safety of oral anticoagulants in the treatment of chronic kidney disease with atrial fibrillation or venous thromboembolism: a systematic review and meta-analysis2025 · 8 citations
  2. 2Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients with Atrial Fibrillation and Bioprosthetic Valve Replacement: An Umbrella Review2025 · 1 citations
  3. 3Effectiveness and safety of direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients with liver disease: a systematic review and meta-analysis2025
  4. 4New aspects of anticoagulant therapy in atrial fibrillation in patients with renal dysfunction2020
  5. 5Comparison of Safety and Effectiveness Between Direct Oral Anticoagulants and Vitamin K Antagonists in Dementia Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis.2025 · 1 citations