Journal Article

Effect of Rivaroxaban or Apixaban in Atrial Fibrillation Patients with Stage 4–5 Chronic Kidney Disease or on Dialysis

Zhu Wengen, Chen, Chen, Ma, Jianyong, Cao Yalin, Liu, Chen, Dong Yugang, Zheng, Ying

2021

Overview

BackgroundAnticoagulant treatment in non-valvular atrial fibrillation (AF) patients with severe chronic kidney disease (CKD) or on dialysis remains a matter of debate. The object of this study was to quantify the benefit-risk profiles of rivaroxaban or apixaban versus warfarin in AF patients with stage 4–5 CKD or on dialysis.MethodA comprehensive search of the Cochrane Library, PubMed, Ovid, and Google Scholar databases was performed for eligible studies that comparing the effect and safety of rivaroxaban or apixaban versus warfarin in AF patients with stage 4–5 CKD or on dialysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were abstracted, and then pooled using a random-effects model.ResultsA total of seven studies, one post hoc analysis of RCT and six observational cohorts, were included in this meta-analysis. Compared with warfarin use, the use of rivaroxaban or apixaban was significantly associated with reduced risks of all-cause death (HR = 0.82, 95% CI 0.72–0.93) and gastrointestinal bleeding (HR = 0.87, 95% CI 0.80–0.95). There were no significant differences in the risks of stroke or systemic embolism (rivaroxaban, HR = 0.71, 95% CI 0.43–1.19; apixaban, HR = 0.86, 95%CI 0.68–1.09) and major bleeding (rivaroxaban, HR = 0.96, 95% CI 0.64–1.45; apixaban, HR = 0.56, 95%CI 0.28–1.12).ConclusionsCurrent evidence suggests that rivaroxaban or apixaban are safe and at least as effective as warfarin in patients with AF and stage 4–5 CKD or on dialysis.

• Publisher: Springer Nature B.V
• Subject: Anticoagulants / Bleeding / Cardiac arrhythmia / Confidence intervals / Dialysis / Embolism / Fibrillation / Hemodialysis / Kidney diseases / Risk assessment / Search engines / Warfarin