Application of rivaroxaban in patients with non-valvular atrial fibrillation and end-stage kidney disease: A systematic review and meta-analysis
BackgroundNowadays, the number of patients with non-valvular atrial fibrillation (NVAF) complicated by end-stage renal disease (ESKD) is increasing. There are significant challenges in anticoagulation with prescription drugs because of the high risk of bleeding and embolism among these patients. How...
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| Format: | Article |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1021959/full |
| _version_ | 1811167039106056192 |
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| author | Zhenzhen Yang Jieya Wang Ye Yuan Tian Cheng Feifei Ren Songsong Wang Songsong Wang Zhiqing Zhang |
| author_facet | Zhenzhen Yang Jieya Wang Ye Yuan Tian Cheng Feifei Ren Songsong Wang Songsong Wang Zhiqing Zhang |
| author_sort | Zhenzhen Yang |
| collection | DOAJ |
| description | BackgroundNowadays, the number of patients with non-valvular atrial fibrillation (NVAF) complicated by end-stage renal disease (ESKD) is increasing. There are significant challenges in anticoagulation with prescription drugs because of the high risk of bleeding and embolism among these patients. However, no randomized controlled trials (RCTs) of warfarin in combination with any non-vitamin K oral anticoagulant (NOACs) have been performed in patients with baseline creatinine clearance (CrCl) <25 ml/min, which makes it difficult to justify the use of anticoagulants in such patients. Then, we aimed to collect and summarize all evidence to enable the anticoagulation of rivaroxaban, which is less cleared by the kidneys, in patients with severe renal insufficiency and to complement and improve the evidence on the use of rivaroxaban for anticoagulation.MethodsThe present systematic review and meta-analysis searched the databases of PubMed, Embase, the Cochrane Library, CNKI, CBM, and Google Scholar for relevant studies from inception to 1 June 2022, with the restriction of English and Chinese. Eligible cohort studies and RCTs that reported efficacy outcomes [composite of stroke and systemic embolism (SSE), ischemic stroke (ICS), and systemic embolization] or safety outcomes [major bleeding, intracranial hemorrhage (ICH), and gastrointestinal bleeding (GIB)] of rivaroxaban in NVAF patients with ESKD were enrolled. Two authors completed the data extraction and quality assessment work, respectively. The Cochrane Collaboration tool for assessing the risk of bias was used for RCTs, and the NEW-Castle Ottawa scale was used for study quality assessment for cohort studies. Dichotomous variables were calculated as risk factors with 95% confidence intervals (CIs), and meta-analysis was performed to probe the effect of research design, rivaroxaban dose, and controlled drug factors on outcomes.ResultsIn total, three studies were included for meta-analysis, involving 6,071 NVAF patients with ESKD, and two studies were included for qualitative analysis. All included studies were at low risk of bias. A meta-analysis demonstrated that mix-dose rivaroxaban caused no statistical discrepancy in the occurrence of thrombotic and bleeding events when compared to the control group (embolism, LogOR: −0.64, 95% CI: −1.05 to −0.23, P:0.25; bleeding, LogOR: −0.33, 95% CI: −0.63 to −0.03, P:0.15), and low-dose rivaroxaban produced similar results (embolism, LogOR: −1.04, 95% CI: −2.15 to 0.07, P:0.61; bleeding, LogOR: −0.81, 95% CI: −1.19 to −0.44, P:0.93).ConclusionIn this study, low-dose rivaroxaban (10 mg, once a day) may benefit more than warfarin in patients with NVAF and ESKD.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42022330973. |
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| institution | Directory Open Access Journal |
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| last_indexed | 2024-04-10T16:02:26Z |
| publishDate | 2023-02-01 |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-5130d19da2f54f61b943d99560c15d9a2023-02-10T10:07:24ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-02-011010.3389/fcvm.2023.10219591021959Application of rivaroxaban in patients with non-valvular atrial fibrillation and end-stage kidney disease: A systematic review and meta-analysisZhenzhen Yang0Jieya Wang1Ye Yuan2Tian Cheng3Feifei Ren4Songsong Wang5Songsong Wang6Zhiqing Zhang7Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, ChinaDepartment of Pharmacy, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, ChinaDepartment of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, ChinaDepartment of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, ChinaDepartment of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, ChinaDepartment of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, ChinaDepartment of Pharmacology, Hebei Medical University, Shijiazhuang, ChinaDepartment of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, ChinaBackgroundNowadays, the number of patients with non-valvular atrial fibrillation (NVAF) complicated by end-stage renal disease (ESKD) is increasing. There are significant challenges in anticoagulation with prescription drugs because of the high risk of bleeding and embolism among these patients. However, no randomized controlled trials (RCTs) of warfarin in combination with any non-vitamin K oral anticoagulant (NOACs) have been performed in patients with baseline creatinine clearance (CrCl) <25 ml/min, which makes it difficult to justify the use of anticoagulants in such patients. Then, we aimed to collect and summarize all evidence to enable the anticoagulation of rivaroxaban, which is less cleared by the kidneys, in patients with severe renal insufficiency and to complement and improve the evidence on the use of rivaroxaban for anticoagulation.MethodsThe present systematic review and meta-analysis searched the databases of PubMed, Embase, the Cochrane Library, CNKI, CBM, and Google Scholar for relevant studies from inception to 1 June 2022, with the restriction of English and Chinese. Eligible cohort studies and RCTs that reported efficacy outcomes [composite of stroke and systemic embolism (SSE), ischemic stroke (ICS), and systemic embolization] or safety outcomes [major bleeding, intracranial hemorrhage (ICH), and gastrointestinal bleeding (GIB)] of rivaroxaban in NVAF patients with ESKD were enrolled. Two authors completed the data extraction and quality assessment work, respectively. The Cochrane Collaboration tool for assessing the risk of bias was used for RCTs, and the NEW-Castle Ottawa scale was used for study quality assessment for cohort studies. Dichotomous variables were calculated as risk factors with 95% confidence intervals (CIs), and meta-analysis was performed to probe the effect of research design, rivaroxaban dose, and controlled drug factors on outcomes.ResultsIn total, three studies were included for meta-analysis, involving 6,071 NVAF patients with ESKD, and two studies were included for qualitative analysis. All included studies were at low risk of bias. A meta-analysis demonstrated that mix-dose rivaroxaban caused no statistical discrepancy in the occurrence of thrombotic and bleeding events when compared to the control group (embolism, LogOR: −0.64, 95% CI: −1.05 to −0.23, P:0.25; bleeding, LogOR: −0.33, 95% CI: −0.63 to −0.03, P:0.15), and low-dose rivaroxaban produced similar results (embolism, LogOR: −1.04, 95% CI: −2.15 to 0.07, P:0.61; bleeding, LogOR: −0.81, 95% CI: −1.19 to −0.44, P:0.93).ConclusionIn this study, low-dose rivaroxaban (10 mg, once a day) may benefit more than warfarin in patients with NVAF and ESKD.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42022330973.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1021959/fullrivaroxabannon-valvular atrial fibrillationend-stage kidney diseasesystematic reviewmeta-analysis |
| spellingShingle | Zhenzhen Yang Jieya Wang Ye Yuan Tian Cheng Feifei Ren Songsong Wang Songsong Wang Zhiqing Zhang Application of rivaroxaban in patients with non-valvular atrial fibrillation and end-stage kidney disease: A systematic review and meta-analysis Frontiers in Cardiovascular Medicine rivaroxaban non-valvular atrial fibrillation end-stage kidney disease systematic review meta-analysis |
| title | Application of rivaroxaban in patients with non-valvular atrial fibrillation and end-stage kidney disease: A systematic review and meta-analysis |
| title_full | Application of rivaroxaban in patients with non-valvular atrial fibrillation and end-stage kidney disease: A systematic review and meta-analysis |
| title_fullStr | Application of rivaroxaban in patients with non-valvular atrial fibrillation and end-stage kidney disease: A systematic review and meta-analysis |
| title_full_unstemmed | Application of rivaroxaban in patients with non-valvular atrial fibrillation and end-stage kidney disease: A systematic review and meta-analysis |
| title_short | Application of rivaroxaban in patients with non-valvular atrial fibrillation and end-stage kidney disease: A systematic review and meta-analysis |
| title_sort | application of rivaroxaban in patients with non valvular atrial fibrillation and end stage kidney disease a systematic review and meta analysis |
| topic | rivaroxaban non-valvular atrial fibrillation end-stage kidney disease systematic review meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1021959/full |
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