Unlabelled: BACKGROUND AND OBJECTIVE: Systematic reviews and meta-analyses of direct oral anticoagulants (DOACs) for patients with chronic kidney disease (CKD) or dialysis patients are lacking. We aimed to compare the efficacy and safety of DOACs and warfarin in patients with CKD requiring anticoagulation therapy.
Methods: We performed a systematic review and meta-analysis of six randomized controlled trials and 19 observational studies, with the inclusion criteria being a comparative study between DOACs and warfarin in patients with CKD or dialysis patients from database inception until August 2020. The efficacy outcomes were stroke, systemic embolism (SE), or venous thromboembolism (VTE), and the safety outcome was major bleeding.
Results: Compared with warfarin, DOACs significantly reduced the risk of stroke/SE/VTE by 22% (hazard ratio [HR] = 0.78, 95% confidence interval [CI] 0.64-0.95) and major bleeding by 17% (HR = 0.83, 95% CI 0.71-0.97). On comparing factor Xa inhibitors and dabigatran with warfarin separately, factor Xa inhibitors significantly reduced the risk of stroke/SE/VTE (HR = 0.78, 95% CI 0.62-0.98) and major bleeding (HR = 0.76, 95% CI 0.64-0.91) overall in patients. Comparing each DOACs with warfarin separately, apixaban was associated with a significantly better risk reduction of stroke/SE/VTE (25% risk reduction) and major bleeding (35% risk reduction) than warfarin. Compared with warfarin, DOACs significantly reduced the risk of stroke, SE, or VTE by 19% (HR = 0.81, 95% CI 0.68-0.97) in patients with CKD stage 3 and significantly lowered the risk of major bleeding by 31% (HR = 0.69, 95% CI 0.56-0.85) in patients with CKD stages 4-5.
Conclusions: In pooled, analyzed randomized controlled trials and observational studies, DOACs were associated with better efficacy in early CKD, as well as similar efficacy and safety outcomes to warfarin in patients with CKD stages 4-5 or dialysis patients. The results of patients with CKD stages 4-5 and dialysis patients were from observational studies. Well-designed randomized controlled trials focused on DOAC use in patients with CKD and dialysis patients are needed. PROSPERO register number: CRD42020150599, 6 February, 2020.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s40261-021-01016-7 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Patient-reported outcome measures for life participation in patients with chronic kidney disease: a systematic review.
Clin Kidney J
January 2025
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Background: The symptoms, comorbidities and treatment burden associated with chronic kidney disease (CKD) can be debilitating and limit life participation in patients with CKD not requiring kidney replacement therapy (KRT). The aim of this study was to identify the characteristics, content and psychometric properties of patient-reported outcome measures (PROMs) used to assess life participation in patients with CKD.
Methods: We searched MEDLINE, Embase, PsycINFO and CINAHL from database inception to February 2023 for all studies that reported life participation in patients with CKD (stages 1-5 not requiring kidney replacement therapy).
Iron management and exercise training in individuals with chronic kidney disease: lived experiences.
Clin Kidney J
January 2025
Department of Population Health Sciences, University of Leicester, Leicester, UK.
Background: Non-anaemic iron deficiency is highly prevalent in people living with chronic kidney disease (CKD) but is underdiagnosed and undertreated, especially in earlier stages of CKD. A multicentre trial assessing the effect of intravenous iron supplementation in iron-deficiency but not anaemic people with CKD included a qualitative sub-study that aimed to explore the patient experience and psychosocial impact of living with CKD and iron deficiency, and the experience of the therapeutic intervention (intravenous iron and exercise).
Methods: Semi-structured interviews were conducted with 23 trial participants blinded to treatment.
Diagnostic Accuracy of Creatinine-Based Equations for eGFR Estimation in Pakistanis: Evaluation of the European Kidney Function Consortium Equation vs the CKD-EPI Pakistan Equation.
EJIFCC
December 2024
Section of Chemical Pathology, Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi, Pakistan.
Introduction: Chronic Kidney Disease (CKD) is prevalent in Pakistan, necessitating accurate diagnostic methods. This study evaluates the CKD-EPI 2009, CKD-EPI 2021, CKD-EPI Pak, MDRD, and EKFC equations against creatinine clearance (CrCl) to determine their diagnostic accuracy for CKD in the Pakistani population.
Methods: n a retrospective cross-sectional study, data from 2,310 participants aged 18-70 were analyzed at The Aga Khan University in Karachi.
Early Versus Late Initiation of Dialysis in CKD Stage 5: Time for a Consensus.
Kidney Int Rep
January 2025
Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA.
Chronic kidney disease (CKD), a major global public health problem, emerged as one of the leading causes of death, affecting over 800 million individuals worldwide, with significant burden to patients and their caregivers, and may lead to end-stage kidney disease (ESKD). The decision on optimal initiation of chronic dialysis is a common problem faced by nephrologists, patients, and caregivers due to lack of adequate data. Determining the ideal time to initiate maintenance dialysis for individuals struggling with ESKD has remained a puzzle.
View Article and Find Full Text PDFUrinary Dickkopf-3 Reflects Disease Severity and Predicts Short-Term Kidney Function Decline in Renal Ciliopathies.
Kidney Int Rep
January 2025
Department of General Pediatrics, University Children's Hospital Münster, Münster, Germany.
Introduction: Phenotypic heterogeneity and unpredictability of individual disease progression present enormous challenges in ultrarare renal ciliopathies. The tubular-derived glycoprotein, Dickkopf-related protein 3 (DKK3) is a promising biomarker for kidney fibrosis and prediction of kidney function decline. Here, we measured urinary DKK3 (uDKK3) levels in 195 pediatric patients with renal ciliopathy to assess its potential as a discriminative and prediction marker.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!