PO-01-063 THE EFFICACY AND SAFETY OF DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONISTS FOR ATRIAL FIBRILLATION IN PATIENTS ON HEMODIALYSIS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

Vitamin K antagonists (VKAs), including warfarin, have been considered the mainstay in the treatment of atrial fibrillation (AF) in patients with end-stage renal disease, warranting hemodialysis. Direct oral anticoagulants (DOACs) have been extensively prescribed for multiple indications; however, hemodialysis patients were excluded from most of the DOACs randomized controlled trials (RCTs). Therefore, the efficacy and safety of DOACs vs. VKAs in hemodialysis patients are still inconclusive. We aim to investigate the safety and efficacy of DOACs versus VKAs for the treatment of AF in hemodialysis patients. We conducted a systematic review and meta-analysis synthesizing RCT, which were retrieved by systematically searching: PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through November 25th, 2022. We used the fixed-effect model to pool the risk ratio (RR) with a 95% confidence interval (CI). Three RCTs with a total of 341 patients (176 in the DOACs group and 165 in the VKAs group) were included in our analysis. For the DOACs arm, two RCTs investigated apixaban, and another investigated rivaroxaban, while for the VKAs arm, two RCTs investigated warfarin and another investigated phenprocoumon. There was no difference between DOACs and VKAs regarding all-cause mortality (RR: 0.99 with 95% CI [0.76, 1.30], P= 0.96), cardiovascular mortality (RR: 1.35 with 95% CI [0.71, 2.60], P= 0.36), non-cardiovascular mortality (RR: 0.75 with 95% CI [0.53, 1.05], P= 0.09), sudden mortality (RR: 1.33 with 95% CI [0.53, 3.33], P= 0.54), any cerebrovascular event (RR: 0.52 with 95% CI [0.21, 1.29], P= 0.16), ischemic stroke (RR: 0.51 with 95% CI [0.19, 1.37], P= 0.18), hemorrhagic stroke (RR: 0.61 with 95% CI [0.10, 3.70], P= 0.59), acute coronary syndrome (RR: 1.27 with 95% CI [0.57, 2.81], P= 0.56), major bleeding (RR: 0.82 with 95% CI [0.47, 1.43], P= 0.48), and minor bleeding (RR: 1.18 with 95% CI [0.79, 1.78], P= 0.42). In AF patients who are on hemodialysis, DOACs and VKAs were similar in terms of efficacy and safety outcomes. However, evidence is still scarce, which warrants more large-scale RCTs to investigate the potentiality of DOACs in this cohort.