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A. Basics
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01. History of Cardiology
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04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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25. Interventional Cardiology
26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Direct oral anticoagulants versus vitamin K antagonists and no anticoagulation in patients with nonvalvular atrial fibrillation and end-stage renal disease or hemodialysis
Session:
Posters (Sessão 5 - Écran 1) - Fibrilhação auricular - clínica
Speaker:
Mariana Rodrigues Simões
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.8 Atrial Fibrillation - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana Rodrigues Simões; Erivaldo Figueiredo Pires Andrade; Luís Paiva; Bárbara Cecília Bessa Dos Santos Oliveiros Paiva; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Aims</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"ArialMT",serif">: To compare the composite outcome of stroke and major bleeding, stroke, major bleeding and all-cause mortality rates between direct oral anticoagulants (DOAC) and vitamin K antagonist (VKA) and no anticoagulation in end-stage renal disease (ESRD) and dialysis patients with nonvalvular atrial fibrillation (AF). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Methods and Results</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"ArialMT",serif">: We systematically searched MEDLINE, Embase and Cochrane Controlled Register of Trials, in November 2022, for studies comparing VKA and DOAC and no anticoagulation in patients with AF and ESRD. Fifteen eligible studies were included: twelve studies compared DOAC versus VKA and two studies examined DOAC versus no anticoagulation treatment. Random effects meta-analysis was performed. Compared with VKA, DOAC was associated with lower rates of the composite outcome overall (pooled OR 0,61 [0.46, 0.80], p=0.0005), lower stroke rate (pooled OR 0.65 [0.53, 0.79], p<0.0001) and lower bleeding complications (OR 0.64, [0.49, 0.84], p=0.0001). The DOAC use was also associated with decreased all-cause mortality compared to VKA (OR 0.54, [0.45, 0.64], p<0.00001). Compared with no anticoagulation, DOAC showed a significant lower incidence of stroke (OR 0.36, [0.19, 0.68], p=0.002) with no difference in major bleeding events. (OR 0.85, [0.48, 1.52], p=0.59) </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Conclusions</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"ArialMT",serif">: In ESRD patients with nonvalvular AF, DOAC reduced stroke, major bleeding and all-cause mortality as compared to VKA. Compared with no anticoagulation, the DOAC reduced stroke rate without significantly increasing major bleeding. </span></span></span></span></p>
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