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It is noted that warfarin group carried a significantly higher annual risk of Further prospective and randomized controlled validation of our results in

AKI than the dabigatran group for those with high CHA2DS2-VASc score a future study is warranted.
(Figure 2).

We also tried to evaluate the risk of AKI in NVAF Asians taking other

DOACs including apixaban, dabigatran, rivaroxaban as compared with

warfarin. In this nationwide retrospective cohort study, 1,381, 3,863, 6,692

and 5,038 NVAF patients with CKD and 4,146, 18,007, 23,971, and 22,118

NVAF patients without CKD taking apixaban, dabigatran, rivaroxaban,

and warfarin, respectively, from June 1, 2012 to December 31, 2016 were

enrolled from the Taiwan National Health Insurance Program. Propensity-

score weighted method was used to balance covariates across study
groups. Patients were followed until occurrence of AKI or end date of

study (December 31, 2016). The results also confirmed that three DOACs ↑ (Figure 1) ↑ (Figure 2)
The mechanisms underlying Dabigatran was associated with a
were all associated with a significantly lower risk of AKI compared with warfarin-related nephropathy (WRN) lower risk of acute kidney injury than

warfarin for both CKD-free (hazard ratio (HR): 0.75, 95%CI: 0.69-0.81 for warfarin among Asians with non-valvular
atrial fibrillation (NVAF) taking oral
apixaban; HR: 0.79, 95%CI: 0.74-0.85 for dabigatran; HR: 0.81, 95% CI: anticoagulants

0.75-0.87 for rivaroxaban) and CKD cohorts (HR: 0.53, 95%CI: 0.45-0.63

for apixaban; HR: 0.63, 95%CI: 0.57-0.69 for dabigatran; HR: 0.63, 95%
CI: 0.58-0.68 for rivaroxaban). No differences in risk of AKI were found

between any two-paired NOACs. The annual incidence of AKI for all

NOACs and warfarin increased gradually as the increment of CHA2DS2-

VASc for both CKD-free and CKD cohorts after propensity score

weighting (Figure 3).

Our results were also supported by other studies showing that dabiagtran

and rivaroxaban were associated with lower risks of several renal

outcomes including more than 30% decline of eGFR, doubling of serum
↑ (Figure 3)
creatinine, and the risk of acute kidney injury (Figure 4). In conclusion, All direct oral anticoagulants (DOACs)
↑ (Figure 4)
use of all DOACs (apixaban, dabigatran, and rivaroxaban), provide for including apixaban, dabigatran, and Dabigatran and rivaroxaban
rivaroxaban, were associated with a
a lower risk of acute kidney injury than warfarin in a large Asian cohort lower risk of acute kidney injury than were associated with lower risks

of several renal outcomes than
patients who did or did not have a history of kidney disease.DOACs may warfarin among Asians with non-valvular warfarin among patients with non-
be a safer alternative to warfarin in Asians with NVAF in terms of the risk atrial fibrillation (NVAF) taking oral valvular atrial fibrillation (NVAF)
anticoagulants
of anticoagulant-related AKI. taking oral anticoagulants

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