Efficacy and safety of novel anticoagulant therapies in patients with chronic kidney disease-a systematic review and meta-analysis
Por:
Martinez, EC, Cruz, CS, Acosta, EYD, Cano, DAA, Espinosa, AM, Martínez, DO, Furman, F, Vera, SO
Publicada:
1 ene 2025
Ahead of Print:
1 nov 2024
Resumen:
Background Chronic Kidney Disease (CKD) significantly increases the risk of cardiovascular diseases, including atrial fibrillation, which usually requires anticoagulant therapy. The effectiveness and safety of direct oral anticoagulants compared to vitamin K antagonists in patients with CKD remain insufficiently studied, particularly in the more advanced stages. Methods This systematic review, registered in PROSPERO (CRD42023410192), adhered to PRISMA guidelines and included randomized clinical trials and cohort studies comparing direct oral anticoagulants and vitamin K antagonists in CKD patients. Major databases were searched, and studies were selected based on strict inclusion criteria. A meta-analysis was performed using random-effects models. Results Twenty-three studies with a total of 465,673 CKD patients were included. Direct oral anticoagulants showed a significant reduction in major bleeding events compared to vitamin K antagonists (Relative Risk [RR] = 0.62, 95% Confidence Interval: 0.49-0.79, p < 0.01) and a non-significant trend toward reducing thromboembolic events (RR = 0.69, 95% Confidence Interval: 0.43-1.14, p = 0.11). Furthermore, direct oral anticoagulants were associated with a significant reduction in all-cause mortality (RR = 0.63, 95% Confidence Interval: 0.43-0.91, p = 0.02). Conclusion Direct oral anticoagulants may offer a safe alternative to vitamin K antagonists in CKD patients, particularly in terms of reducing bleeding risks and potentially improving survival. However, their role in preventing thromboembolic events remains uncertain, highlighting the need for further research, especially in patients with advanced CKD and kidney failure.
Filiaciones:
Martinez, EC:
Univ Nacl Autonoma Mexico, Mexico City, Mexico
Cruz, CS:
Univ Nacl Autonoma Mexico, Mexico City, Mexico
Acosta, EYD:
Univ Autonoma Sinaloa, Sinaloa, Mexico
Cano, DAA:
Univ Monterrey, Monterrey, Mexico
Espinosa, AM:
Univ Nacl Loja, Loja, Ecuador
Martínez, DO:
Univ Texas RGV, Edinburg, TX USA
Furman, F:
Univ Buenos Aires, Buenos Aires, Argentina
Vera, SO:
Univ Catolica Santa Maria, Arequipa, Peru
hybrid, All Open Access; Hybrid Gold Open Access
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