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

Abstract

Background

Anticoagulant 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.

Method

A 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.

Results

A 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).

Conclusions

Current 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.

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Data Availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Code Availability

Review Manager version 5.3 software (the Cochrane Collaboration 2014, Nordic Cochrane Centre Copenhagen, Denmark), the Stata software (version 15.0, Stata Corp LP, College Station, TX), and MetaXL (version 5.3).

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Funding

This study was funded by the National Natural Science Foundation of China (81770392, 81770394, 81700344, 81800344, 81800345), Science and Technology Program Foundation of Guangzhou (201707010124), Guangdong Natural Science Foundation (2017A030310311, 2017A030313795), Young Teachers’ Basic Scientific Research Business Expenses Project (20ykpy72), Medical Research Foundation of Guangdong Province (A2017030, A2018107, A2018082), and China Postdoctoral Science Foundation (2019 M663312, 2019TQ0380, 2019 M660229).

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CL and WZ developed the idea of the study. CC obtained the data and wrote the manuscript, YC performed analysis and interpreted the results. YZ participated in data analysis and results interpretation. JM and YD participated in manuscript writing and revision. All authors have read and approved the manuscript and agreed with their contributions.

Corresponding authors

Correspondence to Wengen Zhu or Chen Liu.

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Chen, C., Cao, Y., Zheng, Y. et al. Effect of Rivaroxaban or Apixaban in Atrial Fibrillation Patients with Stage 4–5 Chronic Kidney Disease or on Dialysis. Cardiovasc Drugs Ther (2021). https://doi.org/10.1007/s10557-021-07144-8

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Keywords

  • Atrial fibrillation
  • Renal insufficiency
  • Anticoagulants
  • Outcome