Key result
DOACs cut major bleeding ~36% vs VKAs in dialysis patients with nonvalvular AF.
Why the study?
While DOACs are superior to VKAs in patients with AF and preserved renal function, evidence in patients with end-stage kidney disease on dialysis remains inconclusive.
Do direct oral anticoagulants improve efficacy and safety outcomes 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.
May support DOAC preference over VKAs for lower bleeding in dialysis AF; extends RCT findings with cohort mortality data but needs confirmation.
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 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.
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Li et al. (2025) 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.
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