Use of Novel Oral Anticoagulants in Patients with Atrial Fibrillation and Moderate to Severe Renal Dysfunction: Findings from a Prospective National Registry

Background: We aimed to prospectively evaluate the clinical characteristics and outcomes of atrial fibrillation (AF) patients with renal dysfunction who receive NOACS with reduced renal elimination (i.e., apixaban or rivaroxaban) in a multicenter national registry.

Methods: The study population comprised 4523 AF patients with eGFR 15-60 ml/min were recruited to a prospective national registry involving 18 cardiology, medicine, and geriatric departments in Israel. All patients were prospectively followed-up for clinical events, compliance, and dosing adjustments, over a mean period of 2 years.

Results: Mean eGFR of study patients was 37 ml/min, and 35% had severe renal dysfunction (eGFR 15-30 ml/min). Low dose apixaban (2.5 mg bid) and rivaroxaban (15 mg) were inappropriately prescribed to 70% and 33% of study patients, respectively (p

Conclusion: Our data from a prospective national registry show a very high rate of NOAC under-dosing in patients with advanced renal dysfunction, which is associated with increased risk of adverse events. Appropriate dosing appears to be effective and safe in this high-risk population.