A comparative analysis of DOACs vs warfarin for venous thromboembolism treatment in renal insufficiency

Aim: Annually, millions of people die from kidney diseases making it a serious public health concern. Patients with renal insufficiency have hemostatic defects that enhance their risk of thrombosis and bleeding. Evaluating the advantages and hazards of anticoagulant thromboprophylaxis is challenging. Material and Methods: By using the fuzzy preference ranking organization method for enrichment evaluation (fuzzy PROMETHEE) and fuzzy multi-criteria optimization and compromise solution (fuzzy VIKOR), which are analytical multi-criteria decision-making (MCDM) techniques, this study aims to analyze diverse types of anticoagulants; specifically, Vitamin K-Antagonist (warfarin) and direct oral anticoagulants namely; Dabigatran, Rivaroxaban, Apixaban, and Edoxaban, by considering various criteria. Results: Direct oral anticoagulants outperformed warfarin in terms of safety and effectiveness. Among all the analyzed anticoagulants, Apixaban was found to be the best-ranked anticoagulant with both fuzzy PROMETHEE and fuzzy VIKOR, with a net flow of 0.0064 and the lowest Qj value of 0.0000, respectively, compared with other alternatives depending on the selected criteria while warfarin was found to be the least ranked anticoagulant with a net flow of -0.0043 and the highest number of Qj being 1, respectively. Conclusion: The MCDM techniques used were effective, highly accurate, and sensitive in the comparison of anticoagulant therapy for venous thrombosis in renal insufficiency based on the chosen criteria. The proper use of a safe and effective anticoagulant will boost better performance not only in patients’ survival and well-being but also in the health care center.