Meta-Analysis of Efficacy and Safety of New Oral Anticoagulants versus Warfarin in Atrial Fibrillation Patients with Chronic Kidney Disease.(Evidence-Based Medicine)
| Autor: | Ya-Lan Chang, 張雅嵐 |
|---|---|
| Rok vydání: | 2014 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 102 Background: Individuals with atrial fibrillation (AF) is the most common sustained abnormal heart rhythm in adults, have a five-fold increased risk of stroke.Using the appropriate antithrombotic drugs to prevent stroke in patients with atrial fibrillation is necessary. Atrial fibrillation and chronic kidney disease have comorbidity, nearly one-third of atrial fibrillation patients have CKD. A meta-analysis of randomized controlled trials was performed to compare the efficacy and safety of new oral anticoagulants ( apixaban, dabigatran and rivaroxaban) to those of warfarin in patients with AF. Patients randomized to new oral anticoagulants had a decreased risk for all-cause stroke and systemic embolism (relative risk [RR] 0.78, 95% confidence interval [CI] 0.67 to 0.92) and a lower risk for intracranial bleeding (RR 0.49, 95% CI 0.36 to 0.66). Data regarding the risks for major bleeding (RR 0.88, 95% CI 0.71 to 1.09) and gastrointestinal bleeding (RR 1.25, 95% CI 0.91 to 1.72) were inconclusive. Objective: To research the relevant literatures of compare stroke and major bleeding risk of new oral anticoagulants and warfarin in atrial fibrillation patients with CKD. Methods: Literature search for evidence-based medicine approach to the use of online databases Medline OVID, Pubmed other search through the literature of the appraisal, to filter appropriate documentation, then meta-analysis software to analyze the results of that. Results: After screening the relevantly random controlled trials in high quality after critical appraisal studies, include 3 random controlled trials finally. Patients with mild renal impairment ( creatinine clearance 50-80 ml/min) randomized to new oral anticoagulants had a decreased risk 22% for stroke and systemic embolism (RR 0.78, 95% CI 0.68-0.89) and decreased risk 19% for major bleeding( RR 0.81, 95%CI 0.74-0.89). Patients with moderate-severe renal impairment( creatinine clearance 30-49ml/min) randomized to new oral anticoagulants had a decreased risk 24% for stroke and systemic embolism( RR 0.76, 95%CI 0.69-0.83) and decreased risk 16% for major bleeding( RR 0.84, 95%CI 0.78-0.89). Conclusion and suggestion: In this study conclusion for atrial fibrillation patients with mild to severe renal impairment, new oral anticoagulants are more effective in prevent stroke or systemic embolism and reduces major bleeding risk. In atrial fibrillation with moderate to severe renal impairment, there was no significant difference between the new anticoagulants and warfarin for major bleeding risk, in addition to apixaban. We suggest that patient with high bleeding risk may select apixaban. It was the most significant that dabigatran 150mg reduce stroke risk, while dabigatran 110mg was no significant advantage for stroke prevention and major bleeding risk. There is no clinical trials directly comparing between new oral anticoagulants, we can only retrieve data from clinical trial results for analysis. In the future, we hope further include more clinical trials designed for atrial fibrillatin patients with renal insufficiency using novel oral anticoagulants to provide more benefit for CKD patients. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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