Direct Oral Anticoagulants vs Vitamin K Antagonists in Chronic Renal Failure

Ann Intern Med. 2016;165:JC43. doi:10.7326/ACPJC-2016-165-8-043

This systematic review and meta-analysis examined 9 randomized, controlled trials comparing direct oral anticoagulants (DOACs) with warfarin (with or without a lovenox bridge) in patients with atrial fibrillation or venous thromboembolism. It found that DOACs are associated with less intracranial hemorrhage than warfarin in patients with creatine clearance (CrCl) levels of less than 50 mL/min (number needed to treat [NNT], 117 [95% CI, 97–174]) and in patients with CrCl levels of 50-80 (NNT, 168 [CI, 143–217]), and less major bleeding in patients with CrCl levels of 50-80 mL/min (NNT, 101 [CI, 70–188]).

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