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Kidney Week

Abstract: FR-OR117

Benefits and Risks of Oral Anticoagulant Therapy in CKD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Ha, Jeffrey, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Neuen, Brendon Lange, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Cheng, Lap Pui, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Jun, Min, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Jardine, Meg J., The George Institute for Global Health, Sydney, New South Wales, Australia
  • Gallagher, Martin P., The George Institute for Global Health, Sydney, New South Wales, Australia
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Perkovic, Vlado, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Badve, Sunil V., The George Institute for Global Health, Sydney, New South Wales, Australia
Background

The effects of anticoagulation in chronic kidney disease (CKD) are uncertain. The aim of this systematic review was to study the benefits and risks of oral anticoagulant therapy in CKD.

Methods

Electronic databases were searched for randomized controlled trials with ≥3 months follow-up in CKD patients (Stage 3-5D) that evaluated oral anticoagulant therapy. Treatment effects were summarized using random-effects meta-analysis.

Results

Nine trials (1341 participants) compared a vitamin K antagonist (VKA) to placebo, no study medication, aspirin, or low molecular weight heparin (LMWH). Twenty-three trials (27849 participants) compared a non-vitamin K oral anticoagulant (NOAC) to VKA, placebo, aspirin, or LMWH. Only 7 VKA trials (663 participants) included patients with advanced CKD, including dialysis patients. There were no clear differences in the risk of all-cause death (7 trials, RR 0.92, 95%CI 0.71, 1.18), and major bleeding (6 trials, RR 1.08, 95%CI 0.61, 1.92) between the VKA and combined control groups. Data on venous thromboembolism (VTE) and stroke or systemic embolism in atrial fibrillation (SSE-AF) with VKA were scant. Compared to VKA, NOAC reduced the risk of SSE-AF (5 trials, RR 0.82, 95%CI 0.70, 0.96), major bleeding (8 trials, RR 0.71, 95%CI 0.51, 0.97), hemorrhagic stroke (3 trials, RR 0.42, 95%CI 0.20, 0.65), and intracranial hemorrhage (3 trials, RR 0.43, 95%CI 0.26, 0.60); and had similar risk of VTE/VTE-related death (4 trials, RR 0.86, 95%CI 0.47, 1.58), and all-cause death (4 trials, RR 0.91, 95%CI 0.78, 1.06). There were no clear differences in the risk of all-cause death (6 trials, RR 0.95, 95%CI 0.82, 1.11), VTE/VTE-related death (7 trials, RR 0.56, 95%CI 0.29, 1.09), and major bleeding (14 trials, RR 1.04, 95%CI 0.74, 1.44) between the NOAC and combined control groups. Compared to placebo, the effect of NOAC on major adverse cardiovascular events was uncertain (3 trials, RR 0.85, 95%CI 0.73, 1.01).

Conclusion

NOAC have a benefit-risk profile superior to VKA in early stages of CKD, with significant reductions in SSE-AF and major bleeding. However, there is insufficient evidence to conclude whether patients with advanced CKD derive benefit from VKA or NOAC.