Novel Oral Anticoagulants in Patients with Renal Insufficiency:A Meta-Analysis of Randomized Trials

The Canadian journal of cardiology (Impact Factor: 3.12). 08/2014; 30(8). DOI: 10.1016/j.cjca.2014.04.015

ABSTRACT Background
Recent reports suggest altered antithrombotic efficacy and higher risk of bleeding with new oral anticoagulants (NOAC) in patients with renal insufficiency. A meta-analysis was performed to evaluate the efficacy and safety with recommended doses of NOAC compared to conventional treatment in patients with renal insufficiency.

PubMed, Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases were searched from January 01, 2001 through March 23, 2014. Randomized controlled trials (RCTs) comparing NOACs (rivaroxaban apixaban, and dabigatran) with comparators (vitamin K antagonist/warfarin, low molecular weight heparin, aspirin, placebo) were selected.

There were 40,693 patients with renal insufficiency in ten trials. Compared to other anticoagulants in patients with mild renal insufficiency there was significantly less major or clinically relevant non-major (CRNM) bleeding (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.72- 0.90) and stroke or systemic embolism (OR 0.70, 95% CI 0.54- 0.92), with NOACs. By random effects meta-analysis, there was significantly less stroke or systemic embolism (OR 0.72, 95% CI 0.57- 0.92) and a trend toward less major or CRNM bleeding (OR 0.82, 95% CI 0.59- 1.14) with the NOACs among patients with moderate renal insufficiency, and this became statistically significant when evaluated using a fixed effects model. NOACs showed efficiency comparable to conventional anticoagulants for prevention of venous thromboembolism (VTE) or related mortality.

In patients with renal insufficiency, recommended doses of novel anticoagulants are noninferior and relatively safe compared to conventional anticoagulants.

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