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Review
. 2024 Feb 5;22(1):17.
doi: 10.1186/s12959-023-00576-2.

Efficacy and safety of anticoagulant for treatment and prophylaxis of VTE patients with renal insufficiency: a systemic review and meta-analysis

Shuangshuang Ma #  1   2 , Guohui Fan #  3   4 , Feiya Xu #  5   2 , Xiaomeng Zhang  6   2 , Yinong Chen  6   2 , Yuzhi Tao  7   2 , Yishan Li  8   2 , Yanshuang Lyu  9   10 , Peiran Yang  11 , Dingyi Wang  12 , Zhenguo Zhai  13 , Chen Wang  14   15   16
Affiliations
Review

Efficacy and safety of anticoagulant for treatment and prophylaxis of VTE patients with renal insufficiency: a systemic review and meta-analysis

Shuangshuang Ma et al. Thromb J. .

Abstract

Patients with venous thromboembolism (VTE) comorbid renal insufficiency (RI) are at higher risk of bleeding and thrombosis. Recommendations in guidelines on anticoagulation therapy for those patients remain ambiguous. The goal of this study is to compare the efficacy and safety between different anticoagulant regimens in VTE patients comorbid RI at different stages of treatment and prophylaxis. We performed English-language searches of Pubmed, EMBASE, and Web of Science (inception to Nov 2022). RCTs evaluated anticoagulants for VTE treatment at the acute phase, extension phase, and prophylaxis in patients with RI and reported efficacy and safety outcomes were selected. The methodological quality of the studies was assessed at the outcome level using the risk-of-bias assessment tool developed by the Cochrane Bias Methods Group. A meta-analysis of twenty-five RCTs was conducted, comprising data from twenty-three articles, encompassing a total of 9,680 participants with RI. In the acute phase, the risk of bleeding was increased with novel oral anticoagulants (NOACs) compared to LMWH (RR 1.29, 95% CI 1.04-1.60). For the prophylaxis of VTE, NOACs were associated with an elevated risk of bleeding compared with placebo (RR 1.31, 95%CI 1.02-1.68). In comparison to non-RI patients, both NOACs and vitamin K antagonists (VKA) could increase the risk of bleeding among RI patients (RR 1.45, 95%CI 1.14-1.84 and RR 1.53, 95%CI 1.25-1.88, respectively) during acute phase, while NOACs may increase the incidence of VTE in RI population (RR 1.74, 95%CI 1.29-2.34). RI patients who are under routine anticoagulation have a significantly higher risk of adverse outcomes. LMWH is the most effective and safe option for VTE treatment or prophylaxis in patients with RI.

Keywords: Efficacy; Meta-analysis; Renal insufficiency; Safety; Venous thromboembolism.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart Abbreviations: VTE, venous thromboembolism; RI, renal insufficiency
Fig. 2
Fig. 2
Comparisons of Different Anticoagulants among Patients with RI in Forest Plot Abbreviations: NOAC, novel oral anticoagulants; VKA, vitamin K antagonist; LMWH, low molecular heparin; UFH, unfractionated heparin
Fig. 3
Fig. 3
Effects of Different Anticoagulants among Patients with and without RI in Forest Plot Abbreviations: NOAC, novel oral anticoagulants; VKA, vitamin K antagonist; LMWH, low molecular heparin.
Fig. 4
Fig. 4
Mechanisms of increased bleeding risk in VTE patients with RI Abbreviations: VTE, venous thromboembolism; RI, renal insufficiency; NOAC, novel oral anticoagulant; VKA, vitamin K antagonist; LMWH, low molecular heparin
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