Direct Oral Anticoagulants Versus Vitamin K Antagonists in Chronic Kidney Disease Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Chronic kidney disease in patients undergoing transcatheter aortic valve replacement requiring long-term anticoagulation (n=32508). Intervention: Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs). Primary outcome: All-cause mortality (RR 0.90, 95% CI 0.81-0.99, p=0.04).

Rosauro Mejia; Arminder Singh; Amol Bahekar; Thirumala Keerthi Chandrika Kammaripalle

doi:10.7759/cureus.79052

February 15, 2025CureusOpen Access

Direct Oral Anticoagulants Versus Vitamin K Antagonists in Chronic Kidney Disease Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

View Full Paper

Ask AI

Bookmark

Share

Key result

Direct oral anticoagulants significantly reduced all-cause mortality (RR 0.90) compared to vitamin K antagonists in chronic kidney disease patients undergoing transcatheter aortic valve replacement.

Figures

Why the study?

Chronic kidney disease complicates anticoagulation in patients undergoing transcatheter aortic valve replacement, warranting a comparison of the efficacy and safety of DOACs versus VKAs in this population.

Do direct oral anticoagulants reduce mortality and major bleeding compared to vitamin K antagonists in chronic kidney disease patients requiring long-term anticoagulation after transcatheter aortic valve replacement?

Study Design

Type

Meta-Analysis (n=32,508)

Multicenter

Yes

Structured PICO

Do direct oral anticoagulants reduce mortality and major bleeding compared to vitamin K antagonists in chronic kidney disease patients requiring long-term anticoagulation after transcatheter aortic valve replacement?

P

Population

32,508 adult patients aged 18 and older with chronic kidney disease (eGFR < 60 mL/minute/1.73 m²) who have undergone transcatheter aortic valve replacement (TAVR) and require long-term anticoagulation (31,501 with moderate CKD, 1,007 with severe CKD).

I

Intervention

Direct oral anticoagulants (DOACs) including apixaban, rivaroxaban, dabigatran, and edoxaban at any approved dosing regimen for at least 3 months.

C

Comparator

Vitamin K antagonists (VKAs) with documented target INR ranges and regular monitoring.

O

Outcome

All-cause mortality and major bleeding events (classified using ISTH criteria or BARC types 3-5).hard clinical

Main Result

Effect estimate: RR 0.90 (95% CI 0.81-0.99)

p-value: p=0.04

Limitations

Most included studies (10/13) were observational, meaning causality cannot be definitively established.
Unmeasured confounders may influence the observed associations.
Limited data and smaller sample sizes in the severe CKD population.
High heterogeneity observed in major bleeding outcomes.
Inadequate accounting for confounding factors in some included observational studies
Relatively short follow-up periods in some studies
Open-label design of included randomized controlled trials
Differential follow-up between groups leading to missing outcome data in some trials

Implication

DOACs demonstrate superior efficacy in reducing mortality and comparable or better safety regarding major bleeding compared to VKAs in patients with moderate CKD requiring anticoagulation after TAVR.

Abstract

Chronic kidney disease (CKD) complicates anticoagulation in transcatheter aortic valve replacement (TAVR) patients in some cases. The aim of this review was to compare the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in this group. We conducted a meta-analysis of 13 studies (32,508 patients) from databases like PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, and Cochrane Library up to September 2024, focusing on all-cause mortality and major bleeding as primary outcomes, with stroke and intracranial hemorrhage as secondary outcomes. DOACs were found associated with reduced mortality (risk ratio (RR): 0.90, 95%CI: 0.81-0.99, p=0.04), particularly in moderate CKD (RR: 0.94, 95%CI: 0.90-0.98, p=0.01). Major bleeding was significantly lower with DOACs in moderate CKD (RR: 0.70, 95%CI: 0.50-0.98, p=0.03), alongside decreased stroke (RR: 0.42, 95%CI: 0.18-0.97) and intracranial hemorrhage (RR: 0.58, 95%CI: 0.36-0.94). DOACs demonstrate superior efficacy in reducing mortality and comparable safety to VKAs in CKD patients post TAVR, especially in moderate CKD. These findings advocate for DOACs as a preferable anticoagulation strategy, with cautious application in severe CKD pending further research.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Mejia et al. (2025) conducted a meta-analysis in Chronic kidney disease in patients undergoing transcatheter aortic valve replacement requiring long-term anticoagulation (n=32,508). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on All-cause mortality (RR 0.90, 95% CI 0.81-0.99, p=0.04). Direct oral anticoagulants significantly reduced all-cause mortality (RR 0.90) compared to vitamin K antagonists in chronic kidney disease patients undergoing transcatheter aortic valve replacement.

synapsesocial.com/papers/6a0864e6ad370a6b44de112c https://doi.org/10.7759/cureus.79052

View Full Paper

Ask AI

Bookmark

Share

Direct Oral Anticoagulants Versus Vitamin K Antagonists in Chronic Kidney Disease Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Direct Oral Anticoagulants Versus Vitamin K Antagonists in Chronic Kidney Disease Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading