Evaluating Renal Benefits of Rivaroxaban Versus Vitamin K Antagonists in Atrial Fibrillation: A Systematic Review and Meta-analysis of Real-world Evidence.

Autor:	Dinh PP; Vietnam National Heart Institute, Bach Mai Hospital Hanoi, Vietnam.; Hanoi Medical University Hanoi, Vietnam., Quang Ho TH; Surgical Intensive Care Unit, Heart Institute Ho Chi Minh City, Vietnam., Pham HM; Vietnam National Heart Institute, Bach Mai Hospital Hanoi, Vietnam.; Hanoi Medical University Hanoi, Vietnam., Nguyen HH; Nhan Dan Gia Dinh Hospital Ho Chi Minh City, Vietnam., Ton MT; Tam Duc Heart Hospital Ho Chi Minh City, Vietnam., Tran GS; Vietnam National Heart Institute, Bach Mai Hospital Hanoi, Vietnam., Vu NQ; Hanoi Heart Hospital Hanoi, Vietnam., Pham HN; Hanoi Heart Hospital Hanoi, Vietnam., Cao SL; Department of Cardiology, University Medical Center Ho Chi Minh City Ho Chi Minh City, Vietnam., Hoang SV; Cardiovascular Department, Cho Ray Hospital Ho Chi Minh City, Vietnam.; University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City, Vietnam.
Jazyk:	angličtina
Zdroj:	European cardiology [Eur Cardiol] 2024 Jun 13; Vol. 19, pp. e05. Date of Electronic Publication: 2024 Jun 13 (Print Publication: 2024).
DOI:	10.15420/ecr.2024.07
Abstrakt:	Background: AF is a global health concern, with systemic complications including renal dysfunction. This systematic review and meta-analysis compares the effects of rivaroxaban, a Factor Xa inhibitor, and vitamin K antagonists (VKAs) on renal outcomes in AF patients. Methods: The study protocol is registered in PROSPERO (ID: CRD42023462756). We systematically searched the PubMed, Embase and Cochrane Library databases from 1 January 2017 to 30 June 2023 for real-world studies comparing the effects of rivaroxaban and VKAs on renal outcomes in AF patients, including acute kidney injury, a .30% decrease in estimated glomerular filtration rate, doubling of serum creatinine and worsening renal function. Subgroup analyses targeted diabetes, pre-existing kidney disease, the elderly (age .65 years) and Asian populations. The risk of bias was assessed used the Robins-I tool. HRs and 95% CIs were synthesised through a random-effects model. Two sensitivity analyses were performed, using a fixed-effects model and excluding conference abstracts. Results: We identified 1,666 records. After screening, 14 studies comparing rivaroxaban and VKAs were included. Rivaroxaban exhibited superiority over VKAs in preventing: acute kidney injury (HR 0.68; 95% CI [0.61.0.77]; p<0.00001); a .30% decrease in estimated glomerular filtration rate (HR 0.71; 95% CI [0.60.0.84]; p<0.0001); doubling of serum creatinine (HR 0.50; 95% CI [0.36.0.70]; p<0.0001); and worsening renal function (HR 0.56; 95% CI [0.45.0.69]; p<0.00001). Subgroup and sensitivity analyses consistently confirmed rivaroxaban's favourable effects on renal outcomes in diabetes, pre-existing kidney disease, the elderly and Asian populations. Conclusion: Our findings support the preference of rivaroxaban over VKAs for renal outcomes in AF. The findings endorse rivaroxaban as the preferred anticoagulant to mitigate renal complications, offering clinicians valuable insights for tailored strategies. Competing Interests: Disclosure: PPD has received honoraria for scientific presentations from Bayer, Boehringer Ingelheim, Astra Zeneca, Novartis, Medtronic, Abbott, Daiichi Sankyo, Pfizer, Sanofi and Merck Serono. THHQ has received honoraria for scientific presentations from Bayer, Boehringer Ingelheim, Astra Zeneca and Menarini. HPM has received honoraria for scientific presentations from Bayer, Servier, Boehringer Ingelheim, Astra Zeneca, Boston Scientific, Medtronic, Abbott, Elixir, Biotronic and Merck Serono. SHV has received honoraria for scientific presentations from Bayer, Boehringer Ingelheim, Astra Zeneca, Menarini, Servier, Merck Serono, Dr. Reddy’s Laboratories and Gedeon Richter. HNH has received honoraria for scientific presentations from Bayer, Boehringer Ingelheim, Pfizer, Merck Serono, Novartis, Sanofi an Roche. NVQ has received honoraria for scientific presentations from Bayer, Boehringer Ingelheim and Pfizer. MTT has received honoraria for scientific presentations from Bayer, Boehringer Ingelheim, Pfizer, Merck Serono and Medtronic. SLC has received honoraria for scientific presentations from Bayer, Boehringer Ingelheim, Astra Zeneca, Novartis, Medtronic, Viatris, Daiichi Sankyo, Pfizer, Otsuka and Merck Serono. All other authors have no conflicts of interest to declare. Funding: The article processing fee was funded by Bayer Vietnam. The funder had no role in the design, execution, interpretation or writing of the study. Data availability: The data are available from the corresponding author upon reasonable request. Trial registration number: CRD42023462756 (Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu