Anticoagulant drugs for patients with atrial fibrillation on dialysis: a systematic analysis and network meta-analysis

作者：Xianfeng Shen, Chao Zhang, Jun Hu, Tao Zhang, Bin Ma · 发表于：Frontiers in Pharmacology · 年份：2023 · DOI：10.3389/fphar.2023.1320939 · 被引用次数：7 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiac Arrhythmias and Treatments、Venous Thromboembolism Diagnosis and Management

Objective: A lack of clarity persists regarding the efficacy and risks associated with direct oral anticoagulants (DOACs) in end-stage renal disease (ESRD) patients with atrial fibrillation (AF) undergoing dialysis, primarily due to limited retrospective studies. Therefore, the objective of this study was to evaluate the existing data and propose a practical protocol for the clinical utilization of DOACs in ESRD patients with AF undergoing dialysis. Methods: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for clinical studies evaluating DOACs in ESRD patients with AF on dialysis published up to 2 February 2023. DOACs included warfarin, dabigatran, apixaban, edoxaban, and rivaroxaban. The outcomes were mortality, ischemic stroke, hemorrhagic stroke, any stroke, gastrointestinal bleeding, major bleeding, intracranial bleeding, and minor bleeding. Results: Compared with placebo, apixaban (HR = 0.97, 95% CI: 0.88–1.07), rivaroxaban (HR = 0.91, 95% CI: 0.76–1.10), and warfarin (HR = 0.96, 95% CI: 0.90–1.01) did not reduce mortality. Regarding direct comparisons of mortality, the comparisons of warfarin vs. apixaban (HR = 0.99, 95% CI: 0.92–1.06), placebo vs. warfarin (HR = 1.04, 95% CI: 0.99–1.11), and rivaroxaban vs. warfarin (HR = 0.96, 95% CI: 0.80–1.14) did not significantly reduce mortality. Based on the surface under the cumulative ranking curve, rivaroxaban (75.53%), warfarin (62.14%), and apixaban (45.6%) were the most effective interve...