Evidence map›Paper›PMID 41182346›Full record

ArticleClinical research in cardiology : official journal of the German Cardiac Society2025

Real-world use of direct oral anticoagulants in atrial fibrillation patients with moderate/severe chronic kidney disease: a propensity score matched analysis from the START registry.

Danilo Menichelli, Gianluca Gazzaniga, Daniela Poli, Gualtiero Palareti, Emilia Antonucci, Arianna Pani, Pasquale Pignatelli, Daniele Pastori, START2 Register Investigators

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In one paragraph

Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02219984 (Phase 4 Study on Clinical History of Patients Who Start a Chronic Anticoagulant Treatment), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02219984 recruitingnot on this map

Phase 4 Study on Clinical History of Patients Who Start a Chronic Anticoagulant Treatment

Typeobservational_patient_registrySponsorGUALTIERO PALARETIRan2011 to 2027Enrolled15,410ConditionsAtrial Fibrillation, Venous Thromboembolism, Heart Valve Diseases or ProsthesisArmsAnticoagulants
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Danilo Menichelli *Department of General Surgery and Surgical Specialty Paride Stefanini, PhD School in Angio-Cardio-Thoracic Pathophysiology And Imaging, Sapienza University of Rome, Rome, Italy.
Gianluca Gazzaniga *Department of General Surgery and Surgical Specialty Paride Stefanini, PhD School in Angio-Cardio-Thoracic Pathophysiology And Imaging, Sapienza University of Rome, Rome, Italy.
Daniela PoliDepartment of Critical Care Medicine, Thrombosis Centre, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
Gualtiero PalaretiArianna Anticoagulazione Foundation, Bologna, Italy.
Emilia AntonucciArianna Anticoagulazione Foundation, Bologna, Italy.
Arianna PaniDepartment of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Pasquale PignatelliDepartment of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Daniele PastoriDepartment of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy. daniele.pastori@uniroma1.it.ORCID http://orcid.org/0000-0001-6357-5213
START2 Register Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChronic kidney disease (CKD) often coexists in patients with atrial fibrillation (AF), worsening patients' prognosis. Direct oral anticoagulants (DOACs) are increasingly used also in patients with AF and CKD, but limited evidence exists regarding outcomes in advanced CKD.

methodsPatients with AF and CKD from the Italian prospective nationwide START registry were included. Patients were divided into three groups based on the estimated glomerular filtration rate (eGFR): (1) eGFR 59-46, (2) 45-30, and (3) 29-15 ml/min/1.73 m

resultsAmong 4849 patients with AF and CKD, the mean age was 81.5 ± 6.7 years, 57.9% were women, and 55.8% were on DOACs. DOAC (vs. VKAs) was inversely associated with all-cause mortality in group 1 (HR 0.49, 95% CI 0.36-0.67, p < 0.001), group 2 (HR 0.42, 95% CI 0.31-0.58, p < 0.001), and group 3 (HR 0.20, 95% CI 0.10-0.39, p < 0.001). Similar results were obtained for CVEs (sHR 0.64, 95% CI 0.49-0.85, p = 0.002 for group 1, sHR 0.56, 95% CI 0.42-0.75, p < 0.001 for group 2, sHR 0.31, 95% CI 0.17-0.55, p < 0.001 for group 3), while no differences emerged for bleedings. No significant differences were observed among DOACs.

conclusionsIn this real-world contemporary cohort of patients with AF receiving oral anticoagulants, DOAC use was associated with a lower risk of all-cause mortality and cardiovascular events across all stages of CKD. Trial registration NCT02219984.

Indexed as

All-cause mortalityAnticoagulantsAtrial fibrillationBleedingChronic kidney disease

Identifiers

PMID41182346

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