NEW ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONISTS IN PATIENTS WITH ATRIAL FIBRILLATION AND STAGE 5 CHRONIC KIDNEY DISEASE UNDER DIALYSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

E-Poster

https://storage.unitedwebnetwork.com/files/1099/954b21dad861528b57ec41fb83c89fc0.pdf

Abstract Title

First Name *

Larissa

Last Name *

Lucena

Co-author 1

Marcos Aurélio Freitas marcosfreitas.20200005210@uemasul.edu.br State University of the Tocantina Region of Maranhão Medicine Imperatriz

Co-author 2

Ana Karenina Souza anakareninacs@gmail.com Federal University of Rio Grande do Norte Health Sciences Natal

Co-author 3

Caroliny Hellen Silva caroliny.silva.706@ufrn.edu.br Federal University of Rio Grande do Norte Health Sciences Natal

Co-author 4

Janine Watanabe jmidorifw@aluno.uespi.br State University of Piauí Medicine Teresina

Co-author 5

Felipe Guedes felipeguedeshuol@gmail.com University Hospital Onofre Lopes Division of Nephrology Natal

Co-author 6

José Bruno Almeida jbrunomd@gmail.com Federal University of Rio Grande do Norte Integrated Medicine Natal

Co-author 7

Rodrigo Oliveira razoliveira@gmail.com Federal University of Rio Grande do Norte Integrated Medicine Natal

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

In patients with atrial fibrillation (AF) and normal or slightly impaired renal function, the use of new oral anticoagulants (NOACs) is preferable to vitamin K antagonists (VKAs). However, in patients undergoing hemodialysis, the efficacy, and safety of NOACs compared with VKAs are still unknown.

Methods

We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials that compared the use of NOACs with VKAs for anticoagulation in patients with AF on dialysis therapy and that evaluated the following outcomes: (1) stroke; (2) major bleeding; (3) cardiovascular mortality; and (4) all-cause mortality. Statistical analysis was performed using RevMan 5.1.7, and heterogeneity was assessed by I2 statistics. P values less than 0.05 were considered statistically significant.

Results

Three randomized controlled trials were included, comprising a total of 383 patients. Of these, 218 received NOACs (130 received apixaban; 88 received rivaroxaban), and 165 were treated with VKAs (116 received warfarin; 49 received phenprocoumon). The incidence of stroke was significantly lower in patients treated with NOACs (3.7%) compared with those using VKAs (7.3%) (RR 0.41; 95% CI 0.18-0.93; p=0.03; I2=0%) (Figure 1A). However, the difference was not statistically significant in the case of ischemic stroke specifically (RR 0.42; 95% CI 0.17-1.04; p=0.06; I2=0%) (Figure 1B). As for the major bleeding outcome, the NOAC group (14.2%) had fewer events than the VKA group (18.2%) but without statistical significance (RR 0.69; 95% CI 0.44-1.07; p=0.10; I2=18%). There was no significant difference between groups regarding cardiovascular mortality (RR 1.23; 95% CI 0.66-2.29; p=0.52; I2=13%) and all-cause mortality (RR 0.98; 95% CI 0.77-1.24; p=0.84; I2=16%).

Conclusions

This meta-analysis suggests that in patients with AF on dialysis, the use of NOACs was associated with a significant reduction in stroke and a numerically lower incidence of major bleeding than VKAs.

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