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Direct Oral Anticoagulants Versus Vitamin K Antagonists in Chronic Kidney Disease Patients Undergoing Transcatheter

Ricardo Rodriguez Mejia1, Arminder Singh1, Amol Bahekar2

  • 1Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA.

Cureus
|February 17, 2025
PubMed

Insights

Direct oral anticoagulants (DOACs) show improved survival and similar safety compared to vitamin K antagonists (VKAs) in patients undergoing transcatheter aortic valve replacement (TAVR) with chronic kidney disease (CKD). DOACs are particularly beneficial for those with moderate CKD.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Anticoagulation management in transcatheter aortic valve replacement (TAVR) patients with chronic kidney disease (CKD) presents unique challenges.
  • Direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) are common anticoagulation strategies, but their comparative effectiveness in CKD patients post-TAVR is not fully established.

Purpose of the Study:

  • To compare the efficacy and safety of DOACs versus VKAs in patients with CKD undergoing TAVR.
  • To analyze outcomes including all-cause mortality, major bleeding, stroke, and intracranial hemorrhage.

Main Methods:

  • A comprehensive meta-analysis was conducted, synthesizing data from 13 studies involving 32,508 patients.
  • Literature search included major databases (PubMed, MEDLINE, Embase, Cochrane Library) up to September 2024.
  • Primary outcomes were all-cause mortality and major bleeding; secondary outcomes included stroke and intracranial hemorrhage.

Main Results:

  • DOACs were associated with a significant reduction in all-cause mortality (RR: 0.90, p=0.04), especially in moderate CKD (RR: 0.94, p=0.01).
  • Major bleeding events were significantly lower with DOACs in moderate CKD (RR: 0.70, p=0.03).
  • DOACs also demonstrated a reduction in stroke (RR: 0.42) and intracranial hemorrhage (RR: 0.58) compared to VKAs.

Conclusions:

  • DOACs represent a superior anticoagulation strategy for improving survival in CKD patients post-TAVR.
  • DOACs offer comparable safety to VKAs, with notable benefits in reducing bleeding and stroke in moderate CKD.
  • Further research is warranted to guide the cautious use of DOACs in patients with severe CKD.

Keywords:
anticoagulationchronic kidney diseasecomplication ratesdirect oral anticoagulantsmeta-analysismortalityrenal impairmentsystematic reviewtranscatheter aortic valve replacementvitamin k antagonists

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