Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation on chronic hemodialysis: a meta-analysis of randomized controlled trials

• Published in: International urology and nephrology 2024-06, Vol.56 (6), p.2001-2010
• Main Authors: Navalha, Denilsa D. P., Felix, Nicole, Nogueira, Alleh, Clemente, Mariana, Marinho, Alice D., Ferreira, Rafael Oliva Morgado, Pasqualotto, Eric, Dagostin, Caroline Serafim, Pinto, Luis Cláudio Santos, Fernandes, Gilson C.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Antagonists; Anticoagulants; Anticoagulants - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Bleeding; Cardiac arrhythmia; Cardiovascular diseases; Clinical trials; End-stage renal disease; Fibrillation; Hemodialysis; Humans; Ischemia; Kidney diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Nephrology; Nephrology - Original Paper; Randomized Controlled Trials as Topic; Renal Dialysis; Statistical analysis; Thromboembolism; Transient ischemic attack; Urology; Vitamin K; Vitamin K - antagonists & inhibitors
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-023-03889-3

Purpose Patients with atrial fibrillation (AF) and end-stage renal disease on chronic hemodialysis are at risk for thromboembolic and bleeding events. We aimed to perform a meta-analysis to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in this population. Methods We systematically searched PubMed, Excerpta Medica Database (EMBASE) and Cochrane Library for randomized controlled trials (RCTs) comparing DOACs with VKAs in patients with AF on chronic hemodialysis from inception to February 2023 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes were reported using risk ratios (RRs) with 95% confidence intervals (CIs). Statistical analyses were performed using R version 4.2.2. Results We selected three RCTs including 341 patients, of whom 176 (51.6%) were randomized to DOACs. Follow-up ranged from 174 days to 3.38 years. There was no significant difference between groups in terms of cardiovascular mortality (RR 1.34; 95% CI 0.69–2.60; p = 0.39), all-cause mortality (RR 0.96; 95% CI 0.72–1.27; p = 0.77), ischemic/uncertain type of stroke or transient ischemic attack (RR 0.50; 95% CI 0.19–1.35; p = 0.17), or major or life-threatening bleeding (RR 0.70; 95% CI 0.39–1.25; p = 0.22). Conclusion In this meta-analysis of three RCTs, no significant difference was observed between DOACs and VKAs in cardiovascular mortality, all-cause mortality, ischemic/uncertain type of stroke or transient ischemic attack, or major or life-threatening bleeding in patients with AF on chronic hemodialysis.