Direct oral anticoagulants significantly reduced the risk of major bleeding (RR 0.64) in RCTs and all-cause death (RR 0.78) in cohort studies compared to vitamin K antagonists in dialysis patients with nonvalvular atrial fibrillation.
Meta-Analysis (n=30,508)
Yes
Do direct oral anticoagulants improve efficacy and safety outcomes compared to vitamin K antagonists in dialysis patients with nonvalvular atrial fibrillation?
In dialysis patients with nonvalvular atrial fibrillation, DOACs may offer a higher net clinical benefit than VKAs, driven by a reduced risk of major bleeding in RCTs and lower all-cause mortality in cohort studies.
Effect estimate: RR 0.64 (95% CI 0.42-0.99)
Absolute Event Rate: 12.3% vs 15.7%
AIMS: For patients with atrial fibrillation (AF) and preserved renal function, direct oral anticoagulants (DOACs) are superior to vitamin K antagonists (VKAs) for stroke prevention. However, the evidence in patients with end-stage kidney disease (ESKD) on dialysis remains inconclusive. In this systematic review and meta-analysis, we aim to compare the efficacy and safety of DOACs and VKAs in dialysis patients with nonvalvular AF. METHODS AND RESULTS: = 80%). No significant differences were found regarding ischemic stroke or systemic embolism and gastrointestinal bleeding. CONCLUSION: In dialysis patients with nonvalvular AF, DOACs were associated with significantly reduced risk for major bleeding in RCTs and significantly reduced risk for all-cause death in cohort studies. These findings suggest that DOACs may provide a higher net clinical benefit compared with VKAs in dialysis patients.
Li et al. (Mon,) conducted a meta-analysis in Nonvalvular atrial fibrillation in end-stage kidney disease patients on dialysis (n=30,508). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Major bleeding (in RCTs) (RR 0.64, 95% CI 0.42-0.99). Direct oral anticoagulants significantly reduced the risk of major bleeding (RR 0.64) in RCTs and all-cause death (RR 0.78) in cohort studies compared to vitamin K antagonists in dialysis patients with nonvalvular atrial fibrillation.