---
title: "Kidney injury signals with DOACs: Comparative analysis of DTIs versus FXaIs"
id: "pubmed-42717832"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42717832"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42717832/"
doi: "10.1080/0886022X.2026.2725468"
published_at: "2026-09-10T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Kidney injury signals with DOACs: Comparative analysis of DTIs versus FXaIs
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42717832
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42717832/)
- **DOI:** [10.1080/0886022X.2026.2725468](https://doi.org/10.1080%2F0886022X.2026.2725468)
- **Published At:** 2026-09-10T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This study compared kidney injury reports linked to **direct oral anticoagulants (DOACs)** using the FAERS database (2008–2024) and a systematic review of published case reports. - A total of 8,116 suspected DOAC-associated kidney injury reports were identified: 1,784 reports for **direct thrombin inhibitors (DTIs)** (dabigatran) and 6,332 reports for **factor Xa inhibitors (FXaIs)** (rivaroxaban, apixaban, edoxaban). - Disproportionality analyses found elevated reporting signals for both classes: DTIs (ROR = 2.081, 95% CI 1.979–2.189; PRR = 2.044, CI 1.947–2.147) and FXaIs (ROR = 1.483, 95% CI 1.444–1.523; PRR = 1.472, CI 1.434–1.510). - Within FXaIs there was marked intra-class variation; **edoxaban** demonstrated the strongest signal (ROR = 4.453, 95% CI 4.021–4.932; PRR = 4.212, 95% CI 3.831–4.632). - Multivariable logistic regression indicated lower kidney injury reporting disproportionality for FXaIs versus DTIs after adjustment (adjusted ROR = 0.687, 95% CI 0.650–0.727, P < 0.001). - Review of 32 detailed case reports revealed differing clinical patterns: DTI-associated cases had higher rates of proteinuria (P = 0.029), while FXaI-associated cases more often involved polypharmacy (P = 0.006) and showed poorer renal recovery (P = 0.023). - The authors conclude that kidney injury risk differs by DOAC class and by individual agents, recommending individualized DOAC selection and closer renal monitoring in clinical practice. - Keywords emphasized by the source include **DOACs**, **direct thrombin inhibitors**, **factor Xa inhibitors**, and **kidney injury**. - The study used FAERS data and published case reports; details about specific case-level management, timing, baseline kidney function, and exact clinical outcomes beyond those summarized were not reported in the abstract.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 10. # Kidney injury associated with direct oral anticoagulants: a comparative study of direct thrombin inhibitors and factor Xa inhibitors based on literature and database analysis [Songhua Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+S&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#full-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Can Shi](https://pubmed.ncbi.nlm.nih.gov/?term=Shi+C&cauthor_id=42717832)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#full-view-affiliation-2 "Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Xiang Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+X&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#full-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Xia Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+X&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#full-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Ren Guo](https://pubmed.ncbi.nlm.nih.gov/?term=Guo+R&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#full-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Tian Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+T&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#full-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China.") Affiliations Expand ### Affiliations * 1 Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China. * 2 Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China. * PMID: **42717832** * DOI: [ 10.1080/0886022X.2026.2725468 ](https://doi.org/10.1080/0886022x.2026.2725468) Item in Clipboard Comparative Study # Kidney injury associated with direct oral anticoagulants: a comparative study of direct thrombin inhibitors and factor Xa inhibitors based on literature and database analysis Songhua Chen et al. Ren Fail. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Ren Fail Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ren+Fail%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ren+Fail%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42717832/) . 2026 Dec;48(1):2725468. doi: 10.1080/0886022X.2026.2725468. Epub 2026 Sep 10. ### Authors [Songhua Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+S&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#short-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Can Shi](https://pubmed.ncbi.nlm.nih.gov/?term=Shi+C&cauthor_id=42717832)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#short-view-affiliation-2 "Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Xiang Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+X&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#short-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Xia Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+X&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#short-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Ren Guo](https://pubmed.ncbi.nlm.nih.gov/?term=Guo+R&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#short-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China."), [Tian Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+T&cauthor_id=42717832)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42717832/#short-view-affiliation-1 "Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China.") ### Affiliations * 1 Department of Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China. * 2 Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China. * PMID: **42717832** * DOI: [ 10.1080/0886022X.2026.2725468 ](https://doi.org/10.1080/0886022x.2026.2725468) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract While direct oral anticoagulants (DOACs) are widely used, limited real-world studies have explored kidney injury linked to DOACs, particularly differences between direct thrombin inhibitors (DTIs) and factor Xa inhibitors (FXaIs). We conducted a comprehensive analysis of kidney injury cases from the FDA Adverse Event Reporting System (FAERS, 2008-2024) and systematically reviewed published case reports, comparing DTIs (dabigatran) with FXaIs (rivaroxaban, apixaban, edoxaban). Among 8,116 reports of suspected DOAC-associated kidney injury, 1,784 were linked to DTIs and 6,332 to FXaIs. Significant reporting rates were observed for DTIs [reporting odds ratio (ROR) = 2.081, 95% CI: 1.979-2.189; proportional reporting ratio (PRR) = 2.044, CI: 1.947-2.147)] and FXaIs (ROR = 1.483, 95% CI: 1.444-1.523; PRR = 1.472, CI: 1.434-1.510). Notably, substantial intra-class variation existed among FXaIs, with edoxaban showing the highest risk signal (ROR = 4.453, 95% CI: 4.021-4.932; PRR = 4.212, 95% CI: 3.831-4.632). Multivariable logistic regression analysis confirmed that significantly lower kidney injury reporting disproportionality signals with FXaIs versus DTIs after adjustment (ROR = 0.687, 95% CI: 0.650-0.727, _P_ < 0.001). Analysis of 32 detailed cases revealed distinct clinical patterns: DTI-associated injury featured higher proteinuria rates (_P_ = 0.029), while FXaI-associated injury occurred more frequently in settings of polypharmacy (_P_ = 0.006) and was associated with poorer renal recovery (_P_ = 0.023). This study demonstrates distinct kidney injury risks among DOAC classes and individual agents, with DTIs and edoxaban showing particularly strong signals. These findings emphasize the need for individualized DOAC selection and enhanced renal monitoring in clinical practice. **Keywords:** Direct oral anticoagulants; direct thrombin inhibitors; factor Xa inhibitors; kidney injury. ## Plain language summary First real-world study comparing DTI and FXaI kidney injury risks.DTIs (dabigatran) had higher kidney injury reporting disproportionality signals (ROR = 2.081, PRR = 2.044) than FXaIs (ROR = 1.483, PRR = 1.472).FXaIs show varied reporting disproportionality signals: edoxaban (ROR = 4.453, PRR = 4.212), followed by rivaroxaban and then apixaban.Multivariable logistic regression analysis confirmed that significantly lower kidney injury reporting disproportionality signals with FXaIs versus DTIs after adjustment (ROR = 0.687, 95% CI: 0.650–0.727, _P_ < 0.001).Findings support class-specific renal monitoring for DOACs. 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