Department of Nephrology, Changxing People's Hospital, Huzhou, Zhejiang Province, P.R. China.
Department of Nephrology, Huzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine, Huzhou, Zhejiang Province, P.R. China.
Expert Rev Hematol. 2021 May;14(5):493-502. doi: 10.1080/17474086.2021.1920012. Epub 2021 May 5.
: No clear clinical guidelines exist on anticoagulant use for chronic kidney disease (CKD) patients. We compared the efficacy and safety of direct-acting oral anticoagulants (DOACs) vs. vitamin K antagonists (VKA) in patients with CKD by pooling data from real-world observational studies.: This systematic review searched PubMed, Embase, and CENTRAL databases and pooled multivariable-adjusted hazard ratios (HR) of outcomes.: Fifteen studies were included. Our results indicated a small but significant reduction in the risk of all-cause mortality (p = 0.01), stroke or systemic embolism (p = 0.03), and major bleeding (p = 0.01) with DOAC as compared to VKA. In subgroup analysis based on the severity of CKD, no difference in the risk of stroke or systemic embolism was noted in any subgroups. The risk of mortality was reduced only in patients with moderate-severe or severe CKD and the risk of major bleeding was reduced only in patients with moderate-severe or moderate CKD.: DOACs are associated with only a modest reduction in stroke or systemic embolism, major bleeding, and mortality when compared to VKA in CKD patients. Reduction in mortality and major bleeding with DOAC may only be seen in moderate-to-severe CKD patients.
目前针对慢性肾脏病（CKD）患者使用抗凝剂，尚无明确的临床指导建议。我们通过汇总真实世界观察性研究的数据，比较了直接口服抗凝剂（DOAC）与维生素 K 拮抗剂（VKA）在 CKD 患者中的疗效和安全性。
本系统评价检索了 PubMed、Embase 和 CENTRAL 数据库，并汇总了结局的多变量校正风险比（HR）。
纳入了 15 项研究。我们的研究结果表明，与 VKA 相比，DOAC 可略微降低全因死亡率（p=0.01）、卒中或全身性栓塞（p=0.03）以及大出血（p=0.01）的风险。根据 CKD 严重程度的亚组分析，任何亚组在卒中或全身性栓塞风险方面均无差异。只有在中重度或重度 CKD 患者中，死亡率的降低才有统计学意义，只有在中重度或中度 CKD 患者中，大出血的风险才降低。
与 VKA 相比，DOAC 仅可略微降低 CKD 患者的卒中或全身性栓塞、大出血和死亡率。DOAC 降低死亡率和大出血的作用可能仅见于中重度 CKD 患者。
