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

• Towards Better Medication Usage in Patients with CKD
  October 26, 2018 | Location: 26A, San Diego Convention Center
  Abstract Time: 05:30 PM - 05:42 PM

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

Jeffrey Ha, MBBS

Jeffrey is a Nephrology trainee from Sydney, Australia. He is also a higher degree research student through The George Institute and passionate about improving the lives of people with chronic kidney disease by conducting research in areas of unmet clinical need.

• Neuen, Brendon Lange, The George Institute for Global Health, Sydney, New South Wales, Australia

Brendon Lange Neuen,

• Cheng, Lap Pui, The George Institute for Global Health, Sydney, New South Wales, Australia

Lap Pui Cheng,

• Jun, Min, The George Institute for Global Health, Sydney, New South Wales, Australia

Min Jun,

• Jardine, Meg J., The George Institute for Global Health, Sydney, New South Wales, Australia

Meg J. Jardine,

• Gallagher, Martin P., The George Institute for Global Health, Sydney, New South Wales, Australia

Martin P. Gallagher,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

• Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Manish M. Sood,

• Perkovic, Vlado, The George Institute for Global Health, Sydney, New South Wales, Australia

Vlado Perkovic,

• Badve, Sunil V., The George Institute for Global Health, Sydney, New South Wales, Australia

Sunil V. Badve,

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.