Efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation combined with chronic kidney...

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Efficacy and safety of direct oral anticoagulants (DOACs) in patients with chronic kidney disease (CKD) and atrial fibrillation (AF) remain inconsistent in current literature.
• A meta-analysis was conducted to evaluate DOACs versus vitamin K antagonists (VKAs) in this patient population.

Purpose of the Study:

• To systematically analyze and compare the efficacy and safety of DOACs against VKAs in patients with AF complicated by CKD.
• To provide evidence-based insights into optimal anticoagulation strategies for AF patients with varying degrees of kidney function.

Main Methods:

• A comprehensive literature search was performed up to May 30, 2023, identifying randomized controlled trials (RCTs).
• Studies included patients with AF and CKD, comparing DOACs with VKAs.
• Efficacy outcomes included stroke and systemic embolism (SE); safety outcomes comprised major bleeding, intracranial hemorrhage (ICH), fatal bleeding, gastrointestinal bleeding (GIB), and clinically relevant non-major bleeding (CRNMB).

Main Results:

• DOACs demonstrated a significant reduction in stroke/SE (OR=0.75) and all-cause mortality (OR=0.84) compared to VKAs.
• Safety analysis revealed that DOACs significantly decreased the risk of major bleeding (OR=0.76), ICH (OR=0.46), and fatal bleeding (OR=0.75).
• However, DOACs did not show a significant reduction in GIB or CRNMB compared to VKAs.

Conclusions:

• DOACs offer enhanced efficacy and improved safety profiles compared to VKAs for AF patients with moderate CKD (90 ml/min > CrCl ≥ 15 ml/min).
• For AF patients with kidney failure (CrCl < 15 ml/min), DOACs exhibit comparable efficacy and safety to VKAs.