Fakhar Latif, Komail K Meer, Zain Shaikh, Ayesha Mubbashir, Umar Khan, Taimur F Usmani, Jenelle Alvares, Maria Imran, Ahmad Shahid, Abdul W Shaikh, Maham Shahid, Ameer Hamza, Ali Salman, Ahmed M Rashid
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The studies that reported OR, RR, or HR for adult AF patients to investigate the efficacy of OAC in CKD, ESRD, and HD were included. Statistical analysis was completed using a generic inverse variance and random-effects model to calculate the combined HR and their corresponding 95% CIs for all outcomes.</p><p><strong>Evidence synthesis: </strong>The meta-analysis included 33 studies with 178,956 patients. The analysis revealed that the DOACs, when compared to VKA, significantly lowered the risk of stroke or systemic embolism (HR: 0.81 [95% CI: 0.70, 0.93]; P=0.002; I<sup>2</sup>=62%), bleeding (HR: 0.77, [95% CI: 0.67, 0.89]; P=0.0003; I<sup>2</sup>=83%), and intracranial hemorrhage (HR: 0.56, [95% CI 0.47, 0.66]; P<0.00001; I<sup>2</sup>=0%). Similarly, the risks of cardiovascular death (HR: 0.88, [95% CI 0.78, 1.00]; P=0.05; I<sup>2</sup>=0%), all-cause mortality (HR: 0.88, [95% CI 0.70, 1.10]; P=0.25; I<sup>2</sup>=96%), and myocardial infarction (HR: 0.80, [95% CI 0.54, 1.17]; P= 0.25; I<sup>2</sup>= 0%) were lowered by DOAC, but the result was insignificant. No significant difference was seen in the risk of gastrointestinal bleeding between DOAC and VKA as well (HR: 0.95, [95% CI 0.75, 1.20]; P=0.65; I<sup>2</sup>=83%).</p><p><strong>Conclusions: </strong>Our meta-analysis confirms that DOACs are effective for managing AF in patients with kidney disease, with potential clinical implications for AF and CKD management. 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引用次数: 0
摘要
简介：本荟萃分析旨在评估直接口服抗凝剂（DOAC）与维生素 K 拮抗剂（VKA）对患有慢性肾病（CKD）、终末期肾病（ESRD）和接受血液透析（HD）且同时患有心房颤动（AF）的患者的疗效：在 MEDLINE、clinicaltrials.gov、EMBASE 和 Cochrane 数据库中全面检索了报告 OAC 治疗对 CKD、ESRD 和 HD 心房颤动患者有用性的相关研究，检索时间从开始到 2023 年 5 月 1 日。纳入的研究报告包括成年房颤患者的 OR、RR 或 HR，以调查 OAC 在 CKD、ESRD 和 HD 患者中的疗效。使用通用逆方差和随机效应模型完成统计分析，计算所有结果的合并 HR 及其相应的 95% CI：荟萃分析共纳入 33 项研究，178956 名患者。分析显示，与 VKA 相比，DOACs 能显著降低中风或全身性栓塞（HR：0.81 [95% CI：0.70, 0.93]；P=0.002；I2=62%）、出血（HR：0.77, [95% CI：0.67, 0.89]；P=0.0003；I2=83%）和颅内出血（HR：0.56, [95% CI 0.47, 0.66]；P2=0%）的风险。同样，DOAC 降低了心血管死亡（HR：0.88，[95% CI 0.78，1.00]；P=0.05；I2=0%）、全因死亡（HR：0.88，[95% CI 0.70，1.10]；P=0.25；I2=96%）和心肌梗死（HR：0.80，[95% CI 0.54，1.17]；P=0.25；I2=0%）的风险，但结果并不显著。DOAC和VKA的胃肠道出血风险也没有明显差异（HR：0.95，[95% CI 0.75，1.20]；P=0.65；I2=83%）：我们的荟萃分析证实 DOACs 可有效控制肾病患者的房颤，对房颤和 CKD 的管理具有潜在的临床意义。进一步的研究应探讨 DOACs 的肾脏保护作用。
Efficacy of oral anticoagulants in chronic kidney disease and hemodialysis patients with atrial fibrillation: a systematic review and meta-analysis.
Introduction: This meta-analysis seeks to evaluate the efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKA) in individuals with chronic kidney disease (CKD), end-stage renal disease (ESRD), and undergoing hemodialysis (HD) who also have atrial fibrillation (AF).
Evidence acquisition: A comprehensive search of MEDLINE, clinicaltrials.gov, EMBASE, and Cochrane Database for relevant studies reporting the usefulness of OAC therapy for CKD, ESRD, and HD patients with AF was conducted from its inception until 1st May 2023. The studies that reported OR, RR, or HR for adult AF patients to investigate the efficacy of OAC in CKD, ESRD, and HD were included. Statistical analysis was completed using a generic inverse variance and random-effects model to calculate the combined HR and their corresponding 95% CIs for all outcomes.
Evidence synthesis: The meta-analysis included 33 studies with 178,956 patients. The analysis revealed that the DOACs, when compared to VKA, significantly lowered the risk of stroke or systemic embolism (HR: 0.81 [95% CI: 0.70, 0.93]; P=0.002; I2=62%), bleeding (HR: 0.77, [95% CI: 0.67, 0.89]; P=0.0003; I2=83%), and intracranial hemorrhage (HR: 0.56, [95% CI 0.47, 0.66]; P<0.00001; I2=0%). Similarly, the risks of cardiovascular death (HR: 0.88, [95% CI 0.78, 1.00]; P=0.05; I2=0%), all-cause mortality (HR: 0.88, [95% CI 0.70, 1.10]; P=0.25; I2=96%), and myocardial infarction (HR: 0.80, [95% CI 0.54, 1.17]; P= 0.25; I2= 0%) were lowered by DOAC, but the result was insignificant. No significant difference was seen in the risk of gastrointestinal bleeding between DOAC and VKA as well (HR: 0.95, [95% CI 0.75, 1.20]; P=0.65; I2=83%).
Conclusions: Our meta-analysis confirms that DOACs are effective for managing AF in patients with kidney disease, with potential clinical implications for AF and CKD management. Further research should explore DOACs' reno-protective effects.
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