Effectiveness and Safety of Direct Oral Anticoagulants in an Asian Population with Atrial Fibrillation Undergoing Dialys
- PDF / 1,743,435 Bytes
- 12 Pages / 595.276 x 790.866 pts Page_size
- 77 Downloads / 225 Views
ORIGINAL ARTICLE
Effectiveness and Safety of Direct Oral Anticoagulants in an Asian Population with Atrial Fibrillation Undergoing Dialysis: A Population-Based Cohort Study and Meta-Analysis Lai-Chu See 1,2,3 & Hsin-Fu Lee 4,5,6,7,8 & Tze-Fan Chao 9,10 & Pei-Ru Li 1 & Jia-Rou Liu 1 & Lung-Sheng Wu 4,5 & Shang-Hung Chang 4,5,11 & Yung-Hsin Yeh 4,5 & Chi-Tai Kuo 4,5 & Yi-Hsin Chan 4,5,12 & Gregory Y. H. Lip 13 Accepted: 6 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Whether direct oral anticoagulants (DOACs) are more effective and safer than warfarin among Asian patients with nonvalvular atrial fibrillation (NVAF) undergoing dialysis remains unclear. Methods We first compared the risks of ischemic stroke/systemic embolism (IS/SE) and major bleeding associated with DOACs compared with warfarin, in NVAF Asians undergoing dialysis using the Taiwan National Health Insurance Research Database (NHIRD) (Aim 1). Next, we searched PubMed and Medline from January 1, 2010 until January 31, 2020, to perform a systematic review and meta-analysis of all observational real-world studies comparing DOACs with warfarin specifically focused on NVAF patients with stage 4 or 5 chronic kidney disease undergoing dialysis (Aim 2). Finally, we tested the hypothesis whether AF patients undergoing dialysis treated with OACs (warfarin and DOACs) would be associated with lower risk of adverse clinical outcomes as compared to those without OACs using the Taiwan NHIRD (Aim 3). Results From June 1, 2012, to December 31, 2017, a total of 3237 and 9263 NVAF patients comorbid with ESRD receiving oral anticoagulant (OACs) (490 on DOAC, 2747 on warfarin) or no OACs, respectively, were enrolled. Propensity score matching was used to balance covariates across the study groups. For the comparison of DOAC vs. warfarin (Aim 1), DOACs had comparable risks of IS/SE and major bleeding to warfarin in our present cohort. From the original 85 results retrieved, nine studies (including our study) with a total of 6490 and 22,494 patients treated with DOACs and warfarin were included in the meta-analysis, respectively. There were 5343 (82%) and 20,337 (90%) patients treated with DOACs and warfarin undergoing dialysis, respectively. The pooled meta-analysis also indicated no difference of the effectiveness (HR:0.90; [95%CI:0.74–1.10]; P = 0.32) and safety outcomes (HR:0.75; [95%CI:0.54–1.05]; P = 0.09) between DOACs and warfarin (Aim 2). For the comparison of OAC (+) vs. OAC (−) (Aim 3), OAC-treatment was associated with a higher risk of IS/SE (hazard ratio (HR):1.54;
* Yi-Hsin Chan [email protected]
6
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
* Gregory Y. H. Lip [email protected]
7
New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan
8
Chang Gung Memorial Hospital, Tucheng branch, Taoyuan City, Taiwan
9
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, New Taipei City, Taiwan
Data Loading...
