Summary

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• This summary is based on the review of 173 systematic review(s)/meta-analysis(es). ^[1-173]
• In AF (atrial fibrillation) patients on dialysis, factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) reduced the risk of stroke or systemic embolism (SSE) compared to VKAs (OR (odds ratio) = 0.37, 95% CI (confidence interval): 0.15-0.93 in RCTs; HR (hazard ratio) = 0.74, 95% CI: 0.57-0.96 in observational studies), with no significant efficacy difference between apixaban and rivaroxaban (p-interaction = 0.44).
• Apixaban showed a reduced risk of thromboembolic events compared to VKAs (vitamin K antagonists) in a French observational study (HR: 0.49, 95% CI: 0.20-0.78); however, studies from the USRDS (United States Renal Data System) database showed no significant difference in stroke risk between apixaban and VKAs in AF patients on dialysis.
• DOACs demonstrated a lower risk of stroke or systemic embolism (SE) than warfarin in both men and women with AF, but women faced a higher risk of gastrointestinal bleeding (GIB) with rivaroxaban and possibly dabigatran compared to warfarin.
• In AF patients, VKAs reduced the risk of cognitive decline more effectively than warfarin, as indicated by Bayesian network meta-analysis (OR = -1.19, 95% CI: -2.35 to -0.06).
• Meta-analysis showed no significant difference in major bleeding between factor Xa inhibitors and VKAs in AF patients on dialysis (OR = 0.65, 95% CI: 0.32-1.33 for RCTs; HR = 0.87, 95% CI: 0.62-1.22 for observational cohorts), while a separate study found apixaban associated with a lower major bleeding risk compared to VKAs (RR: 0.61, 95% CI: 0.48-0.77).
• Observational data suggested that women on rivaroxaban and potentially dabigatran had a higher risk of gastrointestinal bleeding (GIB) compared to those on warfarin.
• Meta-analysis of RCTs demonstrated a reduced risk of intracranial hemorrhage (ICH) with DOACs compared to warfarin, with apixaban specifically showing a lower ICH risk than warfarin and other DOACs.
• Meta-analysis indicated that apixaban had a significantly reduced overall bleeding risk compared to VKAs (HR: 0.58, 95% CI: 0.52-0.65).
• Among AF patients on dialysis, apixaban showed no difference in stroke risk compared to VKAs but was associated with a lower major bleeding risk.
• In elderly patients (>75 years), DOACs demonstrated fewer thromboembolic events and lower intracranial hemorrhage risk than VKAs, with apixaban having the most favorable safety profile.