In dialysis patients with non-valvular AF, DOACs significantly reduced major bleeding risk by 36% versus VKAs (RR 0.64, 95% CI 0.42–0.99) with no significant stroke risk difference.
Do DOACs improve efficacy and safety compared to VKAs in patients with end-stage kidney disease on dialysis and non-valvular atrial fibrillation?
In dialysis patients with non-valvular atrial fibrillation, DOACs demonstrate a favorable safety profile with a significantly lower risk of major bleeding compared to VKAs, without compromising stroke prevention.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Patients with end-stage kidney disease (ESKD) are at an increased risk for atrial fibrillation (AF). In AF patients with preserved renal function, direct oral anticoagulants (DOACs) are superior to vitamin K antagonists (VKAs) for stroke prevention. However, evidence in ESKD patients on dialysis remains inconclusive. Purpose This systematic review and meta-analysis of randomised controlled trials (RCTs) and cohort studies aims to compare the efficacy and safety of DOACs versus VKAs in dialysis patients with non-valvular atrial fibrillation. Methods We conducted a systematic literature search in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. Publications comparing DOACS and VKAs in dialysis patients with non-valvular AF were included. Studies were excluded if patients were not on dialysis or if anticoagulants were indicated for other diagnoses than AF. Bias assessments were conducted using the Risk of Bias-2 tool for RCTs and the Risk of Bias in Non-randomsed Studies - of Interventions (Version 2) tool for cohort studies. Data of RCTs and cohort studies were synthesised separately using RevMan version 5.4.1. Outcomes were reported as risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Results A total of 11 studies were included in this systematic review, 10 of which were included in the meta-analysis, comprising 4 RCTs (269 patients treated with DOACs and 217 patients treated with VKAs), and 6 cohort studies (7,039 patients receiving DOACs and 22,983 patients receiving VKAs). In RCTs, the risk of major bleeding was significantly lower with DOACs (RR: 0.64, 95% CI: 0.42–0.99, I² = 0%), whereas the risks of the composite outcome of ischaemic stroke or systemic embolism (RR: 0.42, 95% CI: 0.17–1.04, I² = 0%), all-cause death (RR: 0.59, 95% CI: 0.33–1.05, I² = 78%), and gastrointestinal bleeding (RR: 0.87, 95% CI: 0.51–1.48, I² = 0%) were not statistically significant. In cohort studies, the risk of all-cause death was significantly lower for patients treated with DOACs with high heterogeneity (RR: 0.78, 95% CI: 0.62–0.98, I² = 80%). No significant differences were found regarding the risks of the composite outcome of ischaemic stroke or systemic embolism (RR: 0.81, 95% CI: 0.56–1.18, I² = 66%), major bleeding (RR: 0.63, 95% CI: 0.35–1.05, I² = 95%), and gastrointestinal bleeding (RR: 0.81, 95% CI: 0.56–1.17, I² = 78%). Conclusion In patients with ESKD on dialysis and non-valvular atrial fibrillation, DOACs demonstrated a favourable safety profile, with a significantly lower risk of bleeding compared with VKAs. No significant reduction in the risk of ischaemic stroke, systemic embolism or all-cause death was observed. In observational studies, the use of DOACs was associated with a significantly lower risk of all-cause death. These findings suggest that DOACs may provide a greater net clinical benefit compared with VKAs in dialysis patients.Forest plots IS/SS & ACD Forest plots MB & GIB
Li et al. (Sat,) reported a other. In dialysis patients with non-valvular AF, DOACs significantly reduced major bleeding risk by 36% versus VKAs (RR 0.64, 95% CI 0.42–0.99) with no significant stroke risk difference.
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