Using oral anticoagulants among chronic kidney disease patients to prevent recurrent venous thromboembolism: A systematic review and meta-analysis

Alhousani, Mohammad M; Malik, Saad Ullah; Abu-Hashyeh, Ahmad; Poznanski, Noah John; Al-Hasan, Sara; Roth, Danielle; Alsharedi, Mohamed; Mustafa, Bisher

doi:10.1016/j.thromres.2020.11.036

Cited by 25 publications

(13 citation statements)

References 41 publications

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“…However, it is still impossible to deny that the severity of renal insufficiency can affect the actions of OACs due to inadequate sample size and a lower event rate. The pairwise meta-analysis by Alhousani et al 31 included 10 RCTs and suggested that DOACs, VKA and low-molecular-weight heparin (LMWH) showed no significant difference in preventing recurrent VTEs among patients with CKD, but DOACs had a significantly lower risk of bleeding events irrespective of the level of renal impairment compared with VKAs. The conclusions were essentially consistent with the results of acute VTE treatment in our pairwise meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of oral anticoagulants for the treatment of venous thromboembolism in the patients with different renal functions: a systematic review, pairwise and network meta-analysis

Yan

Wang

et al. 2022

BMJ Open

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ObjectivesTo compare the efficacy and safety of direct oral anticoagulants (DOACs) in patients with venous thromboembolism (VTE) and different renal functions.DesignSystematic review containing pairwise and Bayesian network meta-analysis of randomised controlled trials (RCTs).Data sourcesMEDLINE, EMBASE and Cochrane Library.Eligibility criteriaRCTs reporting the efficacy and safety outcomes of DOACs in different creatinine clearance (CrCl) subgroups.Data extraction and synthesisData extraction and quality assessment were undertaken by two independent reviewers. Data were pooled using the DerSimonian-Laird method in pairwise meta-analysis. Network meta-analysis within a Bayesian framework was conducted.ResultsData from 10 RCTs were included. In the treatment of acute VTE, DOACs did not significantly reduce recurrent VTE or VTE-related death (OR, 0.96; 95% CI, 0.82 to 1.11) but significantly reduced bleeding events (0.76, 0.68 to 0.90) compared with warfarin. In the extended treatment of VTE, DOACs produced significant benefits in recurrent VTE or VTE-related death (0.23, 0.16 to 0.29), but significantly increased bleeding events (1.86, 1.04 to 3.33) compared with placebo/aspirin. There were no significant differences in efficacy and safety of DOACs among the three CrCl stratified subgroups in acute and extended treatment of VTE (p for subgroup heterogeneity >0.1). Bayesian network meta-analysis suggested that apixaban 2.5 mg and 5 mg two times per day were associated with a lower risk of bleeding than dabigatran, rivaroxaban, warfarin and aspirin in the subgroup with CrCl >80 mL/min.ConclusionsFor the treatment of acute VTE, DOACs are similar to warfarin in reducing recurrent VTE and VTE-related death but are significantly superior to warfarin in reducing the risk of bleeding. For the efficacy and safety of DOACs across different CrCl stratifications (30–50, 50–80 and more than 80 mL/min), no significant difference was found. In light of minimal evidence, apixaban might be associated with a lower risk of bleeding in patients with VTE and CrCl >80 mL/min.PROSPERO registration numberCRD42018090896.

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Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of oral anticoagulants for the treatment of venous thromboembolism in the patients with different renal functions: a systematic review, pairwise and network meta-analysis

Yan

Wang

et al. 2022

BMJ Open

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“…In fact, pivotal RCT have demonstrated a net clinical benefit for NOACs versus VKA with mild-moderate CKD, but there is little evidence in patients with AF and stages 4 42 . Further benefit of NOAC over VKA is in the incidence of anticoagulant-related nephropathy, mainly described after the introduction of VKA treatment although some case with the use of NOAC have been reported 43 . Finally, it is worthy to comment the fact that the difficulty to achieve anticoagulation in range for the VKA is greater when lowest is the GFR.…”

Section: Discussionmentioning

confidence: 99%

Real world data of anticoagulant treatment in non-valvular atrial fibrillation across renal function status

Calderón

Martínez

Fernández

et al. 2022

Sci Rep

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The objective is to assess the impact of anticoagulant treatment in non-valvular atrial fibrillation (AF) and different categories of renal dysfunction in real world. Electronic Health recordings of patients with diagnosis of AF and renal function collected throughout 5 years and classified according to KDIGO categories. Stroke, transitory ischemic attack (TIA), intracranial hemorrhage and all-cause mortality were identified. Anticoagulant treatments during the study period were classified in untreated (never received therapy), VKA, NOAC and Aspirin. The risk of events was calculated by Cox-proportional hazard models adjusted by confounders. A total of 65,734 patients with AF, mean age 73.3 ± 10.49 years old and 47% females and follow-up of 3.2 years were included. KDIGO classification were: G1 33,903 (51.6%), G2 17,456 (26.6%), G3 8024 (12.2%) and G4 6351 (9.7%). There were 8592 cases of stroke and TIA, 437 intracranial hemorrhage, and 9603 all-cause deaths (incidence 36, 2 and 38 per 103 person/year, respectively). 4.1% of patients with CHA2DS2-VASc Score 2 or higher did not receive anticoagulant therapy. Risk of stroke, TIA, and all-cause mortality increased from G1 to G4 groups. Anticoagulant treatments reduced the risk of events in the four categories, but NOAC seemed to offer significantly better protection. Renal dysfunction increases the risk of events in AF and anticoagulant treatments reduced the risk of stroke and all-cause mortality, although NOAC were better than VKA. Efforts should be done to reduce the variability in the use of anticoagulants even in this high risk group.

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“…Chronic Kidney Disease (CKD) and VTE NOACS and other anticoagulants including VKA and LMWH showed no statistical difference in preventing recurrent VTEs among CKD patients. NOACs had a significantly lower risk of major and non-major clinically relevant bleeding irrespective of the level of renal impairment compared to VKAs [18]. The Italian Society of Nephrology suggests that NOAC have at least similar efficacy and safety profiles as VKA in patients with CKD stage G2 (CrCl 60-89 ml/min) to G3b (30-44 ml/min), while in patients with CKD G4 (15-29 ml/min) to G5 (\ 15 ml/min), also on long-term dialysis, NOAC should be used with caution.…”

Section: Special Populationmentioning

confidence: 92%

“…Table 1 describes the dosing regimen of NOACs for initial treatment and secondary prevention of VTE [18].…”

Section: Dosing Of Noacs In Patients With Vtementioning

confidence: 99%

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Expert Recommendations on the Usage of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) from India: Current Perspective and Future Direction

Pai

Kumar²,

George

et al. 2022

Cardiol Ther

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Non-vitamin K antagonist oral anticoagulants (NOACs) are a new class of anticoagulant drugs used in the prevention and treatment of venous thromboembolism (VTE) and atrial fibrillation (AF). Anticoagulation requires the integration of the correct type and dose of oral anticoagulants based on patient characteristic, and therefore therapy needs to be individualized for each patient. Growing scientific evidence from studies on NOACs has led to a better understanding of their benefits and safety. A large amount of available data creates a necessity for an adaptable practical document for the usage of NOACs in India. The current consensus, developed by experts from India, aims to give recommendations on various frequently raised clinical questions with regards to NOACs and its usage. This practical document provides a platform upon which future guidelines, policies, training, and education for the use of NOACs can be tailored.

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Using oral anticoagulants among chronic kidney disease patients to prevent recurrent venous thromboembolism: A systematic review and meta-analysis

Cited by 25 publications

References 41 publications

Comparative efficacy and safety of oral anticoagulants for the treatment of venous thromboembolism in the patients with different renal functions: a systematic review, pairwise and network meta-analysis

Comparative efficacy and safety of oral anticoagulants for the treatment of venous thromboembolism in the patients with different renal functions: a systematic review, pairwise and network meta-analysis

Real world data of anticoagulant treatment in non-valvular atrial fibrillation across renal function status

Expert Recommendations on the Usage of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) from India: Current Perspective and Future Direction

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