Abstract 18820: Bayesian Meta-Analysis of the Novel Oral Anticoagulants versus Warfarin in Patients With Renal Failure

Abstract

The novel oral anticoagulants (NOACS) dabigatran, rivaroxaban and apixaban for prevention of stroke and systemic embolization in atrial fibrillation are attractive alternatives to warfarin. Controversy exists regarding the use of these medication in renal failure. To compare differential benefit, we performed a Bayesian meta-analysis examining the efficacy and safety of the NOACS versus warfarin in patients with renal failure Methods: Using data from the 3 major trials investigating the novel oral anticoagulants, we conducted a Bayesian meta-analysis of patients stratified by creatinine clearance of 80 ml/min. The primary endpoints of stroke and systemic embolization were assessed, along with safety endpoints of major bleeding, if available. A Bayesian analysis was performed on each group, defining probabilities of benefit for the posterior probability. From this data, sequential Bayesian meta-analysis was performed and posterior probabilities were obtained. Results: Posterior probabilities for stroke and systemic embolization indicate that NOACS in patients with CrCl >80 ml/min have an 74.8% probability of benefit over warfarin. In patients with CrCl 50-80 ml/min there is 95.5% probability of benefit. Patients with CrCl <50 ml/min there is a 93.7% probability of benefit of NOACS over warfarin. Analysis of bleeding events using available data showed a trend towards benefit of NOACS versus warfarin in incidence of major bleeding events. Conclusions: The use of novel oral anticoagulants in patients with renal failure confers a high probability of benefit over warfarin in prevention of stroke and systemic embolization. The NOACS appear to have potentially improved bleeding outcomes in this subgroup, though data is limited. This analysis suggests that the novel oral anticoagulants are more effective and are at least as safe in patients with renal failure when compared with warfarin.