DOAC Renal Signals Differ: Dabigatran and Edoxaban Lead

This pharmacovigilance analysis quantifies class- and agent-level differences in kidney injury reporting among direct oral anticoagulants, informing agent selection and renal monitoring in older adults.

dabigatranedoxabanrivaroxabanapixabandirect oral anticoagulantsdirect thrombin inhibitorsfactor Xa inhibitorsacute kidney injuryanticoagulant-related nephropathypharmacovigilanceFAERSdisproportionality analysisgeriatrics Geriatrics / Geriatric Pharmacy

Background Information

DTIs show higher kidney injury risk than FXaIs in DOAC users.

Understanding the differential kidney injury risks associated with direct oral anticoagulants (DOACs) is crucial for safe prescribing, especially in older adult populations. Direct thrombin inhibitors (DTIs) showed higher kidney injury reporting rates than factor Xa inhibitors (FXaIs), with edoxaban presenting the highest risk among FXaIs. These findings highlight the importance of individualized anticoagulant selection and suggest that enhanced renal monitoring may be required for patients on DTIs or edoxaban. Individualized DOAC selection and vigilant renal monitoring are essential to minimize kidney injury risk.

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Authors: Chen S, Shi C, Li X, Wang X, Guo R, Wu T

Citation: Chen S, Shi C, Li X, et al. Kidney injury associated with direct oral anticoagulants: a comparative study of direct thrombin inhibitors and factor Xa inhibitors based on literature and database analysis. Renal failure. 2026;48(1):2725468. doi:10.1080/0886022X.2026.2725468

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

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