Oral anticoagulation in patients with atrial fibrillation and stage IV and V chronic kidney disease: a systematic review and meta-analysis

Abstract Introduction The association between atrial fibrillation (AF) and chronic kidney disease (CKD) is directly proportional carries a higher risk of death, bleeding, thromboembolism (TE). There uncertainty on the clinical benefit direct oral anticoagulants (DOAC) in patients with advanced stages CKD. Purpose To perform systematic review meta-analysis available literature efficacy safety DOAC compared to warfarin AF stage IV V CKD or without hemodialysis. Methods We reviewed PubMed, SCOPUS, EMBASE, LILACS, Google Scholar, Open Gray, Clinical Trials until April 30th, 2021. A standardized search was performed independently by 2 authors. primary endpoint reduction TE (stroke systemic embolism). outcome major additional bleeding outcomes were analyzed as well. included randomized controlled trials observational intervention studies. Results data from 80,771 participating 14 studies (2 sub-analyses 12 studies). bias low, moderate, high 2, 6, 6 studies, respectively. did not find any difference use versus reduce TE; there trend but non statistically significant though (RR: 0.88 [95% CI, 0.72–1.06], I2=18.7%). Apixaban showed similar behaviour low heterogeneity 0.86 0.68–1.08], I2=0%). Conversely, dabigatran 0.73 0.37–1.42], I2=17%) rivaroxaban 1.08 0.62–1.89], I2=49%) neutral distribution had (Figure 1). reduced significantly 0.9 0.67–1.21], I2=80.6%), apixaban have lower it 0.7 0.46–1.08], I2=53.3%). Rivaroxaban expressed 0.94 0.66–1.35], I2=68.3%), clear inclination increase 1.42 0.99–2.04], I2=6.6%) 2). Dabigatran increased gastrointestinal our studied population 1.49 1.08–2.05]), although this conclusion obtained one study. Conclusion rate TE. apixaban, reach significance due inclusion study hemodialysis that represent subgroup patients. Major pattern, expressing non-statistically be group, especially apixaban. 49% population. Funding Acknowledgement Type funding sources: None.