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Medicine (Baltimore). 2019 Oct;98(42):e17628. doi: 10.1097/MD.0000000000017628.

Effect of anticoagulation therapy in older patients with chronic kidney disease and atrial fibrillation: A meta-analysis.

Author information

1
Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi.
2
Department of Cardiovascular Medicine, Xiangdong Hospital Hunan normal University, Liling of Hunan.
3
Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou of Guangdong.
4
Department of Critial Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou of Jiangxi 341000, China.

Abstract

BACKGROUND:

The role of anticoagulation therapy for stroke prevention in older atrial fibrillation (AF) patients with chronic kidney disease (CKD) remains unclear. Therefore, we conducted a meta-analysis to explore the efficacy and safety of anticoagulation therapy in this population.

METHODS:

The Cochrane Library, PubMed, and Embase databases were systematically searched for studies reporting the effect of anticoagulation therapy in older patients with AF and CKD. The risk ratios (RRs) and 95% confidence intervals (CIs) were regarded as the risk estimates. A random-effects model selected was to evaluate the treatment outcomes. The presentations were based on the Preferred Reporting Items for reporting systematic reviews and meta-analyses statement.

RESULTS:

A total of 7 studies with 24,794 older patients with AF and CKD were included. The follow-up of the included studies ranged from 0.9 to 9.0 years. In older patients with no dialysis, compared with nonanticoagulants, anticoagulants reduced the risk of all-cause death (RR 0.66, 95% CI 0.54-0.79), but had comparable risks of ischemic stroke/transient ischemic attack (TIA, RR 0.91, 95% CI 0.46-1.79) and bleeding (RR 1.17, 95% CI 0.86-1.60). In older patients with dialysis, compared with nonanticoagulants, anticoagulants increased the risk of bleeding (RR 1.37, 95% CI 1.09-1.74), but had similar risks of ischemic stroke/TIA (RR 1.18, 95% CI 0.88-1.58) and death (RR 0.87, 95% CI 0.60-1.27).

CONCLUSION:

Compared with nonanticoagulation, anticoagulation therapy is associated with a reduced risk of death in older AF patients with nondialysis, but an increased risk of bleeding in older patients with dialysis.

PMID:
31626146
DOI:
10.1097/MD.0000000000017628
[Indexed for MEDLINE]
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