Reviews in cardiovascular medicine最新文献

{"title":"Direct Oral Anticoagulants vs. Vitamin K Antagonists for Atrial Fibrillation in Cardiac Amyloidosis: A Systematic Review and Meta-analysis.","authors":"Qinling Nong, Shucheng Liang, Wengen Zhu, Yili Chen, Tang Zhang","doi":"10.31083/RCM26948","DOIUrl":"https://doi.org/10.31083/RCM26948","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to systematically review and synthesize evidence comparing direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) for anticoagulation in patients with atrial fibrillation (AF) and cardiac amyloidosis (CA).</p><p><strong>Methods: </strong>A comprehensive search of PubMed and EMBASE databases was conducted through January 2024 to identify studies comparing DOACs and VKAs in AF patients with CA. Eligible studies underwent rigorous screening and data extraction to evaluate safety and efficacy outcomes.</p><p><strong>Results: </strong>Four studies met the criteria. The first study reported similar embolic event rates between DOACs (3.9%) and VKAs (2.9%) per 100 patient years, while major bleeding rates were 5.21% and 3.74%, respectively. The second paper found stroke rates of 2% for DOACs and 4% for VKAs, with bleeding complications observed in 10% of DOAC patients compared to 20% in VKA patients. The third cohort demonstrated that DOACs were associated with significantly lower risks of stroke and major bleeding compared to VKAs. The last study reported embolic event rates of 1.6 and 2.0 per 100 patient years for DOACs and VKAs, respectively. In the pooled analysis, DOACs were associated with a reduced risk of thromboembolic events (odds ratio [OR] = 0.52; 95% confidence interval [CI]: 0.32-0.84), and no difference in major bleeding between the two groups (OR = 0.61, 95% CI: 0.25-1.51).</p><p><strong>Conclusions: </strong>Existing studies support the use of DOACs as a non-inferior therapeutic option compared to VKAs for preventing thromboembolism in patients with AF and cardiac amyloidosis. DOACs may also offer practical advantages, including reduced bleeding risks and ease of management, but further high-quality randomized controlled trials are needed to confirm these findings and guide clinical practice.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"26948"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Metabolic Syndrome Score and Subclinical Atherosclerosis.","authors":"Ming Yi, Xinyi Wang, Yan Li, Xuewen Li, Jin Si, Yinghua Zhang, Keling Xiao, Lijie Sun, Haoyu Zhang, Jinghao Sun, Zhaoli Liu, Jiaying Lin, Yuxin Xie, Bingyan Zhang, Jing Zhao, Xi Chu, Jing Li","doi":"10.31083/RCM26811","DOIUrl":"https://doi.org/10.31083/RCM26811","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have presented conflicting results on the correlation between metabolic syndrome (MetS) and subclinical atherosclerosis. However, the binary MetS definition cannot reflect the severity of metabolic disorders continuously and dynamically. The present study calculated the MetS score and explored the association between MetS score and subclinical atherosclerosis.</p><p><strong>Methods: </strong>A total of 840 participants were included in this observational, cross-sectional study; 66.55% of participants were men, and the median age was 61.00 years (53.00, 67.00). Brachial-ankle pulse wave velocity (baPWV) and brachial flow-mediated dilation (bFMD) values were measured from October 2016 to January 2020. Spearman's correlation and multiple linear regression analyses were conducted to explore the correlation between the MetS score and baPWV and bFMD. Arterial stiffness was defined as baPWV ≥1400 cm/s, while endothelial dysfunction was described as bFMD >6%. Multiple logistic regression was performed to explore the effects of MetS and MetS score on arterial stiffness and endothelial dysfunction.</p><p><strong>Results: </strong>The MetS score was significantly associated with baPWV (β = 73.59, 95% CI (42.70, 104.48); <i>p</i> < 0.001) and bFMD (β = -0.43, 95% CI (-0.75, -0.10); <i>p</i> = 0.010) after adjusting for covariates. Compared with the binary definition of MetS, the MetS score was a more significant predictor for arterial stiffness (odds ratio, OR = 2.63, 95% CI (1.85, 3.74); <i>p</i> < 0.001) and endothelial dysfunction (OR = 1.33, 95% CI (1.01, 1.76); <i>p</i> = 0.040). Leukocyte count (r = 0.32; <i>p</i> < 0.001) and high-sensitivity C-reactive protein (hs-CRP) (r = 0.17; <i>p</i> < 0.001) values were related to the MetS score.</p><p><strong>Conclusions: </strong>The MetS score is a clinically accessible assessment of metabolic status that can identify individuals at higher risk of subclinical atherosclerosis.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"26811"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytokines are the Basis of the Development and Suppression of Inflammation in Atherosclerosis.","authors":"Alexander V Blagov, Alexey V Churov, Irina A Starodubtseva, Tatiana I Kovyanova, Tamara B Pecherina, Vasily N Sukhorukov","doi":"10.31083/RCM26421","DOIUrl":"https://doi.org/10.31083/RCM26421","url":null,"abstract":"<p><p>Cardiovascular diseases continue to be the primary cause of mortality in industrialised countries, and atherosclerosis plays a role in their development. A persistent inflammatory condition affecting big and medium-sized arteries is known as atherosclerosis. It is brought on by dyslipidemia and is facilitated by the immune system's innate and adaptive components. At every stage of the progression of atherosclerosis, inflammation plays a crucial role. It has been demonstrated that soluble factors, or cytokines, activate cells involved in the pathophysiology of atherosclerosis and have a significant impact on disease progression. Anti-inflammatory cytokines (such as interleukin (IL)-5 and IL-13) mitigate atherosclerosis, whereas pro-inflammatory cytokines (such as IL-1, IL-6) quicken the disease's course. Of interest is the fact that a number of cytokines can exhibit both atherogenic and atheroprotective properties, which is the topic of study and discussion in this review. This review provides a comparative analysis of the functions of the main cytokines involved in the pathogenesis of atherosclerosis. Their functional relationships with each other are also shown. In addition, potential therapeutic strategies targeting these cytokines for the treatment of atherosclerosis are proposed, with an emphasis on recent clinical research in this area.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"26421"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arrhythmic Risk Stratification and Sudden Cardiac Death Prevention in Duchenne Muscular Dystrophy: A Critical Appraisal.","authors":"Domenico D'Amario, Alessandra Arcudi, Maria Lucia Narducci, Valeria Novelli, Francesco Canonico, Alessandro Parodi, Gabriele Dell'Era, Marco Di Francesco, Renzo Laborante, Josip Andelo Borovac, Mattia Galli, Eugenio Maria Mercuri, Giuseppe Vergaro, Antonio Dello Russo, Anthea Tonia D'Amico, Antonio Bisignani, Rachele Adorisio, Giulio Pompilio, Giuseppe Patti","doi":"10.31083/RCM27089","DOIUrl":"https://doi.org/10.31083/RCM27089","url":null,"abstract":"<p><p>Duchenne muscular dystrophy (DMD) is a genetic progressive neuromuscular disorder characterized by early-onset proximal muscle weakness and significant long-term pulmonary and cardiac involvement. Due to the early pharmacological treatments and the wider adoption of non-invasive ventilation, life expectancy has significantly increased in recent years, highlighting the relevance of DMD-related cardiomyopathy and fatal arrhythmias, especially in the late stage of the disease. Current guideline-derived evaluation of sudden cardiac death (SCD) in DMD lacks accuracy, leading to inadequate arrhythmic risk stratification and jeopardized SCD prevention strategies. This review aims to outline these critical issues, proposing an integrative approach encompassing manifold tools such as an imaging-derived systematic and comprehensive evaluation (speckle-tracking echocardiography and magnetic resonance imaging), the electrophysiological study, the 3-dimensional electroanatomic mapping, and a multidimensional clinical examination. This approach might lead to more personalized management along with an effective arrhythmia-prevention strategy aiming to balance clinical care goals, patient expectations, and ethical considerations.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"27089"},"PeriodicalIF":1.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Generic Medications Be a Safe and Effective Alternative to Brand-Name Drugs for Cardiovascular Disease Treatment? A Systematic Review and Meta-Analysis.","authors":"Bing Luo, Feng Yu, Weihong Ge, Xian Yang","doi":"10.31083/RCM26116","DOIUrl":"https://doi.org/10.31083/RCM26116","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiovascular disease is the leading cause of death in most of the world. Previous meta-analyses of generic drugs for the treatment of cardiovascular disease have not provided sufficient evidence to demonstrate the true efficacy and safety of the drugs. Subsequently, concern exists regarding whether the use of generic drugs can fully substitute brand-name drugs in clinical treatment. To enhance the evidence for generic drugs, this meta-analysis compares the actual effectiveness of generic drugs with brand-name drugs in preventing and treating cardiovascular diseases. This study aimed to resolve the controversy over whether generic drugs in cardiovascular disease can replace brand-name drugs, fully evaluating the best evidence on the clinical equivalence of generic drugs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov databases were searched. The search period included articles published before December 2023. Studies on generic and branded cardiovascular drugs were collected, and two independent reviewers screened eligibility, extracted study data, and assessed the risk of bias. Safety outcomes included major adverse cardiovascular events and other adverse events. Efficacy outcomes included relevant vital signs (e.g., blood pressure, heart rate, urine volume) and laboratory measures (e.g., international normalized ratio, low-density lipoprotein cholesterol, platelet aggregation inhibition). A meta-analysis and subgroup analysis were conducted using the Rev Man software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 4238 studies were retrieved, and 87 studies (n = 2,303,818) were included in the qualitative analysis. There were 57 quantitatively assessed studies (n = 560,553), including angiotensin II receptor blockers, beta-blockers, calcium channel blockers, antithrombotic drugs (anticoagulants or antiplatelet agents), diuretics, statins, and other classes of cardiovascular medications. Regarding clinical safety, 19 studies assessed the occurrence of major adverse cardiovascular events (MACEs) (n = 384,640), and 35 reported secondary adverse events (n = 580,125). In addition to the MACEs for statins (risk ratio (RR) 1.13 [1.05, 1.21]) and adverse events (AEs) for calcium channel blockers (RR 0.90 [0.88, 0.91]), there were no significant differences in the overall risk of MACEs (RR = 1.02 [0.90, 1.15]) and minor adverse events (RR = 0.98 [0.91, 1.05]) between generic and brand-name cardiovascular drugs. In terms of effectiveness, there were no significant differences observed between the two groups in blood pressure (BP), platelet aggregation inhibition (PAI), international normalized ratio (INR), low-density lipoprotein (LDL), and urinary sodium levels. Subgroup analyses for the region, study design, duration of follow-up, and grant funding revealed no significant differences in the risk of MACEs. However, the risk of AE was significantly higher in the Asian region fo","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"26116"},"PeriodicalIF":1.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Determinants of Health in the Development of Cardiovascular-kidney-metabolic Syndrome.","authors":"Xinyi Cai, Tuo Li","doi":"10.31083/RCM26580","DOIUrl":"https://doi.org/10.31083/RCM26580","url":null,"abstract":"<p><p>Cardiovascular-kidney-metabolic (CKM) syndrome is characterized by the interactions among the metabolic risk factors, chronic kidney diseases (CKD) and cardiovascular diseases (CVD). Social determinants of health (SDOH) include society, economy, environment, community and psychological factors, which correspond with cardiovascular and kidney events of the CKM population. SDOH are integral components throughout the entire spectrum of CKM, acting as key contributors from initial preventative measures to ongoing management, as well as in the formulation of health policies and the conduct of research, serving as vital instruments in the pursuit of health equity and the improvement of health standards. This article summarizes the important role of SDOH in CKM syndrome and explores the prospects of comprehensive management based on SDOH. It is hoped that these insights will offer valuable contributions to improving CKM-related issues and enhancing health standards.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"26580"},"PeriodicalIF":1.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of Renal Dysfunction in Patients with Severe Tricuspid Regurgitation and Chronic Heart Failure.","authors":"Beniamino Rosario Pagliaro, Pier Pasquale Leone, Alessandro Villaschi, Francesca Pugno Vanoni, Matteo Biroli, Ferdinando Loiacono, Marta Pellegrino, Giuseppe Pinto, Marta Maccallini, Matteo Pagnesi, Giuliana Cimino, Laura Lupi, Damiano Regazzoli Lancini, Renato Maria Bragato, Giulio Stefanini, Bernhard Reimers, Daniela Pini, Marco Metra, Gianluigi Condorelli, Marianna Adamo, Antonio Mangieri, Antonio Colombo","doi":"10.31083/RCM26080","DOIUrl":"https://doi.org/10.31083/RCM26080","url":null,"abstract":"<p><strong>Background: </strong>Renal dysfunction (RD) is common in patients with heart failure (HF), however its impact on clinical outcomes in patients with tricuspid regurgitation (TR) and HF is still debated; therefore, we aimed to assess the impact of RD on clinical outcomes in this population.</p><p><strong>Methods: </strong>All patients with HF and a prevalent or incident diagnosis of TR presenting at two centers between January 2020 and July 2021 were enrolled, in both acute (in-hospitalized patients) and chronic settings (outpatient). Patients were stratified according to the degree of RD (Group 1 <30 mL/min (n = 70), Group 2 30-59 mL/min (n = 123) and Group 3 ≥60 mL/min (n = 56).</p><p><strong>Results: </strong>Out of 249 patients, those with severe RD had lower left ventricular ejection fraction (41.8 ± 13.1% vs. 45.7 ± 14.2% vs. 48.6 ± 13.1%, <i>p</i> = 0.020) and tricuspid annular plane systolic excursion (16.6 ± 3.7 mm vs. 17.6 ± 4.0 mm vs. 20.0 ± 4.4 mm, <i>p</i> < 0.001) while brain natriuretic peptides levels were higher (979 ± 1514 pg/mL vs. 490 ± 332 pg/mL vs. 458 ± 543 pg/mL, <i>p</i> = 0.049) than in the other subgroups. After a median follow-up of 279 (interquartile range, IQR 195-481) days, all-cause mortality was higher in patients with severe RD (37.7% vs. 23.3% vs. 13.7%, <i>p</i> = 0.012). HF hospitalizations (32.7% vs. 31.2% vs. 30.6%, <i>p</i> = 0.970) and the composite of all-cause mortality or HF hospitalization (54.1% vs. 47.9% vs. 42.0%, <i>p</i> = 0.444) did not differ between subgroups.</p><p><strong>Conclusions: </strong>Severe RD is highly present in patients with HF and TR and is associated with increased incidence of all-cause mortality.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"26080"},"PeriodicalIF":1.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of 4D Flow MRI-derived Wall Shear Stress in Aortic Disease: A Comprehensive Review.","authors":"Ying Liu, Xiaolin Mu, Yixin Wang, Zhe Xu, Yang Song","doi":"10.31083/RCM26735","DOIUrl":"https://doi.org/10.31083/RCM26735","url":null,"abstract":"<p><p>Aortic diseases, such as aortic dissection and aortic rupture, often lead to catastrophic complications, significantly increasing morbidity and mortality. Population-based screening for early detection in asymptomatic individuals is not feasible due to high costs and practical challenges. However, recent advancements in four dimensions (4D) Flow magnetic resonance imaging (MRI) offer a comprehensive tool for evaluating hemodynamic changes within the aortic lumen. This technology allows for the quantification and visualization of flow patterns and the calculation of advanced hemodynamic parameters, such as wall shear stress (WSS). WSS is crucial in the development, risk stratification, and surgical outcomes of aortic diseases and their complications, enabling noninvasive and quantitative screening of high-risk populations. This review explores the current status and limitations of 4D flow MRI-derived WSS imaging for aortic disease.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"26735"},"PeriodicalIF":1.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Insight on Atherosclerosis Mechanism and Lipid-Lowering Drugs.","authors":"Penghui Li, Wei Jiang","doi":"10.31083/RCM25321","DOIUrl":"https://doi.org/10.31083/RCM25321","url":null,"abstract":"<p><p>Atherosclerosis (AS) is a chronic vascular disease primarily affecting large and medium-sized arteries, involving complex pathological mechanisms such as inflammatory responses, lipid metabolism disorders and vascular plaque formation. In recent years, several emerging research hotspots have appeared in the field of atherosclerosis, including gut microbiota, pyroptosis, ferroptosis, autophagy, cuproptosis, exosomes and non-coding RNA. Traditional lipid-lowering drugs play a crucial role in the treatment of AS but are not able to significantly reverse the pathological changes. This article aims to summarize the latest research progress in the pathogenesis of AS and the diagnosis and treatment of the disease by comprehensively analyzing relevant literature mainly from the past five years. Additionally, the mechanisms of action and research advances of statins, cholesterol absorption inhibitors, fibrates and novel lipid-lowering drugs are reviewed to provide new insights into the diagnosis and treatment of AS.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"25321"},"PeriodicalIF":1.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation Strategies for Atrial Fibrillation in CKD Stage G5 and Dialysis Patients: An Updated Scoping Review.","authors":"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","doi":"10.31083/RCM26736","DOIUrl":"https://doi.org/10.31083/RCM26736","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 3","pages":"26736"},"PeriodicalIF":1.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}