title: Safety of antithrombotic drugs in patients with atrial fibrillation and non-end-stage chronic kidney disease: Meta-analysis and systematic review.
abstract: OBJECTIVE
  To evaluate the safety of antithrombotic drugs used in patients with both atrial fibrillation (AF) and non-end-stage chronic kidney disease (NECKD).
  
  
  METHODS
  A search was performed for studies on major bleeding outcomes in patients with concurrent AF and NECKD using Medline and Cochrane databases on 19th February, 2015. Fixed- or random-effects meta-analysis was adopted for evaluating pooled effect sizes according to whether heterogeneity existed.
  
  
  RESULTS
  Twelve articles were included for analysis. Three studies evaluated AF patients who took warfarin vs. placebo/antiplatelet drugs in the presence of NECKD. No significant difference in major bleeding risk was observed according to the pooled analysis using the random-effects model (RR: 1.05, 95% CI: 0.74-1.36). The risk of a composite of major bleeding outcomes was reduced by 19% in patients randomized to direct oral anticoagulants (DOACs) compared to dose-adjusted warfarin from pooled data of three randomized controlled trials with regard to AF and NECKD (RR: 0.81, 95% CI: 0.75-0.88). This superiority of DOACs to warfarin maintained until the renal function was severely impaired.
  
  
  CONCLUSIONS
  In patients with AF and NECKD, no significant increase in the incidence of major bleeding outcomes was observed in warfarin use compared with placebo/antiplatelet drugs. DOACs reduced the risk of major bleeding by 19% compared to warfarin and further data-exploration indicated that the risk did not increase as renal function deteriorated during the renal status of mild to moderate impairment.
authors.affiliation: Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Bai
authors.affiliation: School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
authors.forename: Xin-Yao
authors.initials: XY
authors.lastname: Liu
authors.affiliation: Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
authors.forename: Xu-Bo
authors.initials: XB
authors.lastname: Shi
authors.affiliation: Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, 100029, China. Electronic address: chshma@vip.sina.com.
authors.forename: Chang-Sheng
authors.initials: CS
authors.lastname: Ma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D014859:Warfarin
keywords: Atrial fibrillation; Direct oral anticoagulants; Major bleeding; Non-end-stage chronic kidney disease; Warfarin