Anticoagulation Strategies for Atrial Fibrillation in CKD Stage G5 and Dialysis Patients: An Updated Scoping Review.

IF 1.9 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Reviews in cardiovascular medicine Pub Date : 2025-03-05 eCollection Date: 2025-03-01 DOI:10.31083/RCM26736
Heitor Martins de Oliveira, Lorrany Pereira Barros, Maria Clara Azzi Vaz de Campos, Rafael Ferreira Daher, Gil Batista Gonçalves, Mateus Teodoro Sequeira, Silvia Marçal Botelho, Antonio da Silva Menezes Junior
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Abstract

Clinical trials of direct oral anticoagulants (DOACs) often exclude patients with advanced chronic kidney disease (CKD), creating uncertainty regarding their safety and efficacy compared with warfarin. This study addresses this gap by providing key insights into anticoagulation in this high-risk population. This study evaluated the effectiveness and safety of DOACs compared to warfarin and no anticoagulation therapy in atrial fibrillation (AF) patients with CKD stage G5 or on dialysis. This scoping review followed a six-stage framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An exhaustive search of four databases identified relevant papers published through August 2024. The data extraction process was conducted independently, with subsequent qualitative and quantitative analyses conducted. Among the 33 studies included in the final analysis, DOACs, particularly apixaban, were associated with a 20-30% decreased major bleeding risk compared to warfarin. Stroke incidence was comparable between DOACs and vitamin K antagonists (VKAs), with apixaban showing improved prevention in severe CKD. Observational studies reported slightly lower mortality rates with DOACs, particularly apixaban, including fewer cardiovascular-related deaths than with VKAs. DOACs, particularly apixaban and rivaroxaban, demonstrate a favorable safety profile compared to warfarin, but show inconsistent evidence in balancing thromboembolic prevention and bleeding risks in patients with AF and CKD stage G5 or on dialysis. Future studies should focus on optimizing dosing strategies and evaluating long-term safety and efficacy.

直接口服抗凝药(DOACs)的临床试验常常将晚期慢性肾病(CKD)患者排除在外,从而导致其与华法林相比的安全性和有效性存在不确定性。本研究弥补了这一空白,为这一高风险人群的抗凝治疗提供了重要见解。本研究评估了 DOAC 与华法林和不进行抗凝治疗相比,对 CKD G5 期或正在透析的心房颤动 (AF) 患者的有效性和安全性。本范围界定综述遵循六阶段框架和系统综述和荟萃分析首选报告项目 (PRISMA) 指南。通过对四个数据库进行详尽检索,确定了截至 2024 年 8 月发表的相关论文。数据提取过程独立进行,随后进行定性和定量分析。在纳入最终分析的 33 项研究中,与华法林相比,DOACs(尤其是阿哌沙班)的大出血风险降低了 20%-30%。DOAC和维生素K拮抗剂(VKA)的中风发生率相当,阿哌沙班对重度慢性肾脏病患者的预防效果更好。观察性研究报告显示,DOAC(尤其是阿哌沙班)的死亡率略低于 VKAs,其中与心血管相关的死亡人数更少。与华法林相比,DOACs(尤其是阿哌沙班和利伐沙班)具有良好的安全性,但在平衡房颤和 CKD G5 期或透析患者的血栓栓塞预防和出血风险方面,证据并不一致。未来的研究应侧重于优化剂量策略并评估长期安全性和有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Reviews in cardiovascular medicine
Reviews in cardiovascular medicine 医学-心血管系统
CiteScore
2.70
自引率
3.70%
发文量
377
审稿时长
1 months
期刊介绍: RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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