Apixaban and rivaroxaban reduced stroke/systemic embolism (RR 0.57; 95% CI 0.46-0.72) and major bleeding (RR 0.57; 95% CI 0.51-0.63) compared with VKAs in patients with AF and ESRD.
Meta-Analysis
Do apixaban and rivaroxaban reduce stroke/systemic embolism, mortality, and bleeding compared to vitamin K antagonists in patients with atrial fibrillation and end-stage renal disease?
In patients with atrial fibrillation and end-stage renal disease, apixaban and rivaroxaban are associated with lower risks of bleeding, stroke, and mortality compared to VKAs, though large RCTs are needed to confirm efficacy.
Estimación del efecto: RR 0.57 (95% CI 0.46-0.72)
This study aimed to evaluate the comparative efficacy and safety of apixaban and rivaroxaban versus vitamin K antagonists (VKAs) in anticoagulation management in a dialysis population. PubMed, Embase, and the Cochrane Library were searched for studies comparing apixaban or rivaroxaban with VKAs in patients with atrial fibrillation (AF) undergoing dialysis. The primary efficacy endpoints included stroke/systemic embolism (SSE) and all-cause mortality. Safety outcomes encompassed major bleeding, intracranial hemorrhage, and gastrointestinal bleeding. Risk ratios (RR) with 95% confidence intervals (CI) were synthesized using random-effects models. The meta-analysis included three randomized controlled trials (RCTs) and eight observational studies. Pooled analyses showed that apixaban and rivaroxaban were associated with lower risks of major bleeding (RR 0.57, 95% CI: 0.51-0.63), gastrointestinal bleeding (RR 0.66, 95% CI: 0.57-0.76), and intracranial hemorrhage (RR 0.54, 95% CI: 0.36-0.83) compared with VKAs. Additionally, apixaban and rivaroxaban were associated with reduced risk of SSE (RR 0.57, 95% CI: 0.46-0.72) and all-cause mortality (RR 0.73, 95% CI:0.63-0.83), although substantial heterogeneity was present. Exploratory dose-stratified analyses suggested both standard- and low-dose apixaban regimens were associated with favorable efficacy and hemostatic safety relative to warfarin. Consistent numerical trends were observed in the RCT-only analysis, though none reached statistical significance owing to limited sample size. In conclusion, apixaban and rivaroxaban are associated with lower risks of bleeding compared with VKAs in patients with AF and ESRD. However, evidence regarding their efficacy in preventing SSE, all-cause mortality and the optimal apixaban dosing regimen remains inconclusive and requires validation in large, dedicated RCTs.
Wu et al. (Wed,) conducted a meta-analysis in Atrial fibrillation with end-stage renal disease. Apixaban and rivaroxaban vs. Vitamin K antagonists (VKAs) was evaluated on Stroke/systemic embolism (SSE) (RR 0.57, 95% CI 0.46-0.72). Apixaban and rivaroxaban reduced stroke/systemic embolism (RR 0.57; 95% CI 0.46-0.72) and major bleeding (RR 0.57; 95% CI 0.51-0.63) compared with VKAs in patients with AF and ESRD.