Anticoagulation for Patients With Concomitant Atrial Fibrillation and End‐Stage Renal Disease: A Systematic Review and Network Meta‐Analysis
Background Concomitant atrial fibrillation and end‐stage renal disease is common and associated with an unfavorable prognosis. Although oral anticoagulants have been well established to prevent thromboembolism, the applicability in patients under long‐term dialysis remains debatable. The study aimed...
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Wiley
2024-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.034176 |
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| author | Ting‐Wei Kao Zheng‐Wei Chen Yen‐Hung Lin |
| author_facet | Ting‐Wei Kao Zheng‐Wei Chen Yen‐Hung Lin |
| author_sort | Ting‐Wei Kao |
| collection | DOAJ |
| description | Background Concomitant atrial fibrillation and end‐stage renal disease is common and associated with an unfavorable prognosis. Although oral anticoagulants have been well established to prevent thromboembolism, the applicability in patients under long‐term dialysis remains debatable. The study aimed to determine the efficacy and safety of anticoagulation in the dialysis‐dependent population. Methods and Results An updated network meta‐analysis based on MEDLINE, EMBASE, and the Cochrane Library was performed. Studies published up to December 2022 were included. Direct oral anticoagulants (DOACs, dabigatran, rivaroxaban, apixaban 2.5/5 mg twice daily), vitamin K antagonists (VKAs), and no anticoagulation were compared on safety and efficacy outcomes. The outcomes of interest were major bleeding, thromboembolism, and all‐cause death. A total of 42 studies, including 3 randomized controlled trials, with 185 864 subjects were pooled. VKAs were associated with a significantly higher risk of major bleeding than either no anticoagulation (hazard ratio [HR], 1.47; 95% CI, 1.34–1.61) or DOACs (DOACs versus VKAs; HR, 0.74 [95% CI, 0.64–0.84]). For the prevention of thromboembolism, the efficacies of VKAs, DOACs, and no anticoagulation were equivalent. Nevertheless, dabigatran and rivaroxaban were associated with fewer embolic events. There were no differences in all‐cause death with the administration of VKAs, DOACs, or no anticoagulation. Conclusions For dialysis‐dependent populations, dabigatran and rivaroxaban were associated with better efficacy, while dabigatran and apixaban demonstrated better safety. No anticoagulation was a noninferior alterative, and VKAs were associated with the worst outcomes. |
| format | Article |
| id | doaj-art-b79e6e3d10aa4671af2a4f78a7efa16f |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-b79e6e3d10aa4671af2a4f78a7efa16f2025-08-20T02:26:37ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-04-0113810.1161/JAHA.123.034176Anticoagulation for Patients With Concomitant Atrial Fibrillation and End‐Stage Renal Disease: A Systematic Review and Network Meta‐AnalysisTing‐Wei Kao0Zheng‐Wei Chen1Yen‐Hung Lin2Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei TaiwanDepartment of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei TaiwanDepartment of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei TaiwanBackground Concomitant atrial fibrillation and end‐stage renal disease is common and associated with an unfavorable prognosis. Although oral anticoagulants have been well established to prevent thromboembolism, the applicability in patients under long‐term dialysis remains debatable. The study aimed to determine the efficacy and safety of anticoagulation in the dialysis‐dependent population. Methods and Results An updated network meta‐analysis based on MEDLINE, EMBASE, and the Cochrane Library was performed. Studies published up to December 2022 were included. Direct oral anticoagulants (DOACs, dabigatran, rivaroxaban, apixaban 2.5/5 mg twice daily), vitamin K antagonists (VKAs), and no anticoagulation were compared on safety and efficacy outcomes. The outcomes of interest were major bleeding, thromboembolism, and all‐cause death. A total of 42 studies, including 3 randomized controlled trials, with 185 864 subjects were pooled. VKAs were associated with a significantly higher risk of major bleeding than either no anticoagulation (hazard ratio [HR], 1.47; 95% CI, 1.34–1.61) or DOACs (DOACs versus VKAs; HR, 0.74 [95% CI, 0.64–0.84]). For the prevention of thromboembolism, the efficacies of VKAs, DOACs, and no anticoagulation were equivalent. Nevertheless, dabigatran and rivaroxaban were associated with fewer embolic events. There were no differences in all‐cause death with the administration of VKAs, DOACs, or no anticoagulation. Conclusions For dialysis‐dependent populations, dabigatran and rivaroxaban were associated with better efficacy, while dabigatran and apixaban demonstrated better safety. No anticoagulation was a noninferior alterative, and VKAs were associated with the worst outcomes.https://www.ahajournals.org/doi/10.1161/JAHA.123.034176anticoagulationatrial fibrillationchronic kidney diseasedialysismeta‐analysis |
| spellingShingle | Ting‐Wei Kao Zheng‐Wei Chen Yen‐Hung Lin Anticoagulation for Patients With Concomitant Atrial Fibrillation and End‐Stage Renal Disease: A Systematic Review and Network Meta‐Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease anticoagulation atrial fibrillation chronic kidney disease dialysis meta‐analysis |
| title | Anticoagulation for Patients With Concomitant Atrial Fibrillation and End‐Stage Renal Disease: A Systematic Review and Network Meta‐Analysis |
| title_full | Anticoagulation for Patients With Concomitant Atrial Fibrillation and End‐Stage Renal Disease: A Systematic Review and Network Meta‐Analysis |
| title_fullStr | Anticoagulation for Patients With Concomitant Atrial Fibrillation and End‐Stage Renal Disease: A Systematic Review and Network Meta‐Analysis |
| title_full_unstemmed | Anticoagulation for Patients With Concomitant Atrial Fibrillation and End‐Stage Renal Disease: A Systematic Review and Network Meta‐Analysis |
| title_short | Anticoagulation for Patients With Concomitant Atrial Fibrillation and End‐Stage Renal Disease: A Systematic Review and Network Meta‐Analysis |
| title_sort | anticoagulation for patients with concomitant atrial fibrillation and end stage renal disease a systematic review and network meta analysis |
| topic | anticoagulation atrial fibrillation chronic kidney disease dialysis meta‐analysis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.034176 |
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