Arrhythmias & electrophysiology
Efficacy and safety of direct oral anticoagulants (DOACs) vs vitamin K antagonists in patients with atrial fibrillation and chronic kidney disease undergoing hemodialysis: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis
Pooled result · Total stroke (a composite of ischemic and hemorrhagic stroke)Result — go to the resultRelative risk 0.40 95% CI 0.17–0.92Authors' conclusion
In this meta-analysis, DOACs were associated with a lower risk of total stroke and major bleeding. However, DOACs and VKA groups exhibited similar rates of ischemic stroke, all-cause and cardiovascular death, clinically relevant nonmajor bleeding, and gastrointestinal bleeding.
Study context
- Population
- Patients with atrial fibrillation (AF) undergoing dialysis
- Participants
- 486 patients4 randomized controlled trial studies
- Comparison
- Compare DOACs and vitamin K antagonists (VKAs) in patients with AF undergoing dialysis
- Outcome
- Total stroke:
- Ischemic
- Hemorrhagic stroke
Methodological detailsrandomized controlled trial studies, random effects model
- Randomized controlled trial studies
- Random effects model
Pooled result
As reported in the abstract
Relative risk
0.40
95% CI 0.17–0.92
P = 0.031
DOACsvs VKAs
RR 0.40 (95% CI 0.17–0.92); P = 0.031
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Ischemic strokeI2 = 0% | 0.42 (0.17–1.04) | P = 0.062 | |
| All-cause deathI2 = 47% | 0.88 (0.57–1.35) | P = 0.567 | |
| Cardiovascular deathI2 = 0% | 1.13 (0.60–2.10) | P = 0.700 | |
| 0.10.31310Relative risk (log scale) |
Follow-up
- Median follow-up ranged
- 5.8 to 18 months
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Major bleedingI2 = 0% | 0.64 (0.41–0.98) | P = 0.044 | |
| Clinically relevant nonmajor bleedingI2 = 0% | 1.11 (0.67–1.84) | P = 0.669 | |
| 0.512Relative risk (log scale) |
Original publication
Efficacy and safety of DOACs vs vitamin K antagonists in patients with atrial fibrillation and chronic kidney disease undergoing hemodialysis: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Heart Rhythm. Published 7 February 2025. doi:10.
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