Abstract 96: Efficacy and Safety of Oral Anticoagulants in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Abstract

Introduction: Data regarding the efficacy and safety of oral anticoagulants [vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC)] among patients with chronic kidney disease (CKD) remain scarce. Methods: We conducted a systematic review and meta-analysis of studies involving CKD patients treated on OACs. The following outcomes were evaluated: ischemic stroke (IS), intracerebral hemorrhage (ICH), combined ischemic and hemorrhagic stroke (stroke combined ), stroke or systemic embolism (S/SE), mortality, and major bleeding events. CKD was defined based on creatinine clearance (CrCl) as determined by Cockgroft-Gault formula, ranging from mild (CrCl: 60-89 ml/min), moderate (CrCl: 30-59 ml/min) and severe (CrCl: 15-29 ml/min). Patients with CrCl<15ml/min on hemodialysis or underwent transplantation were excluded. Results: We identified 16 studies (7 comparing DOAC vs. VKA & 9 comparing VKA vs. no VKA) comprising 88,610 patients. VKA use (vs. no VKA) was associated with reduced risk of IS [RR=0.71 (95%CI: 0.58-0.88), I 2 =55%] and mortality [RR=0.70 (95%CI: 0.62-0.78), I 2 =66%], but increased the risk of ICH [RR=1.57 (95%CI: 1.22-2.02), I 2 =0%]. In comparison to VKA, DOAC use demonstrated lower risk of ICH [RR=0.43 (95%CI: 0.33-0.56), I 2 =13%], stroke combined [RR=0.83 (95%CI: 0.72-0.96), I 2 =0%], S/SE [RR=0.73 (95%CI: 0.62-0.85), I 2 =45%] and major bleeding [RR=0.77 (95%CI: 0.66-0.90), I 2 =72%]. In adjusted analyses, VKA use (vs. no VKA) was associated with reduced mortality [HR adj =0.68 (95%CI: 0.61-0.76), I 2 =49%], whereas DOAC (vs. VKA) use reduced the risk of ICH [HR adj =0.39 (95%CI: 0.30-0.50), I 2 =0%] and S/SE [HR adj =0.75 (95%CI: 0.65-0.88), I 2 =14%]. Our sensitivity analyses comparing different DOACs showed that factor Xa inhibitors consistently reduced stroke combined [RR=0.84 (95%CI: 0.73-0.96), I 2 =0%], mortality [RR=0.84 (95%CI: 0.70-1.00), I 2 =0%], ICH [RR=0.45 (95%CI: 0.24-0.85), I 2 =42%] and major bleeding [RR=0.76 (95%CI: 0.64-0.91), I 2 =48%]. Conclusions: Amongst CKD patients treated with OAC, DOACs present with a better safety and efficacy profile in various cardiovascular outcomes.