{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T15:51:09Z","timestamp":1770133869097,"version":"3.49.0"},"reference-count":78,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":418,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic Kidney Disease (CKD) significantly increases the risk of cardiovascular diseases, including atrial fibrillation, which usually requires anticoagulant therapy. The effectiveness and safety of direct oral anticoagulants compared to vitamin K antagonists in patients with CKD remain insufficiently studied, particularly in the more advanced stages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review, registered in PROSPERO (CRD42023410192), adhered to PRISMA guidelines and included randomized clinical trials and cohort studies comparing direct oral anticoagulants and vitamin K antagonists in CKD patients. Major databases were searched, and studies were selected based on strict inclusion criteria. A meta-analysis was performed using random-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-three studies with a total of 465,673 CKD patients were included. Direct oral anticoagulants showed a significant reduction in major bleeding events compared to vitamin K antagonists (Relative Risk [RR]\u2009=\u20090.62, 95% Confidence Interval: 0.49\u20130.79, p\u2009&amp;lt;\u20090.01) and a non-significant trend toward reducing thromboembolic events (RR\u2009=\u20090.69, 95% Confidence Interval: 0.43\u20131.14, p\u2009=\u20090.11). Furthermore, direct oral anticoagulants were associated with a significant reduction in all-cause mortality (RR\u2009=\u20090.63, 95% Confidence Interval: 0.43\u20130.91, p\u2009=\u20090.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Direct oral anticoagulants may offer a safe alternative to vitamin K antagonists in CKD patients, particularly in terms of reducing bleeding risks and potentially improving survival. However, their role in preventing thromboembolic events remains uncertain, highlighting the need for further research, especially in patients with advanced CKD and kidney\u00a0failure.\u00a0<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s40620-024-02130-3","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T11:51:33Z","timestamp":1732881093000},"page":"111-126","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy and safety of novel anticoagulant therapies in patients with chronic kidney disease\u2014a\u00a0systematic review and meta-analysis"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2237-9536","authenticated-orcid":false,"given":"Ernesto","family":"Calderon Martinez","sequence":"first","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de M\u00e9xico, Ciudad de Mexico, M\u00e9xico 1"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camila","family":"Sanchez Cruz","sequence":"additional","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de M\u00e9xico, Ciudad de Mexico, M\u00e9xico 1"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edna Y.","family":"Diarte Acosta","sequence":"additional","affiliation":[{"name":"Universidad Aut\u00f3noma de Sinaloa, Sinaloa, M\u00e9xico 2"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Alejandro","family":"Aguirre Cano","sequence":"additional","affiliation":[{"name":"Universidad de Monterrey, Monterrey, M\u00e9xico 3"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Maria","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Univesidad Nacional de Loja, Loja, Ecuador 4"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Oth\u00f3n Mart\u00ednez","sequence":"additional","affiliation":[{"name":"University of Texas RGV, Edinburg, TX, USA 5"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flor","family":"Furman","sequence":"additional","affiliation":[{"name":"Universidad de Buenos Aires, Buenos Aires, Argentina 6"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Obando Vera","sequence":"additional","affiliation":[{"name":"Universidad Catolica de Santa Maria, Arequipa, Per\u00fa 7"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,11,29]]},"reference":[{"key":"2026012110521323300_CR1"},{"key":"2026012110521323300_CR2","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1097\/MNH.0000000000000634","article-title":"Direct oral anticoagulants in chronic kidney disease: an update","volume":"29","author":"Mavrakanas","year":"2020","journal-title":"Curr Opin Nephrol Hypertens [Internet]"},{"key":"2026012110521323300_CR3","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1161\/CIRCULATIONAHA.119.044059","article-title":"Apixaban versus warfarin in patients with atrial fibrillation and advanced chronic kidney disease","volume":"141","author":"Stanifer","year":"2020","journal-title":"Circulation [Internet]"},{"key":"2026012110521323300_CR4","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.3390\/ijerph19031436","article-title":"Safety and efficacy of DOACs in patients with advanced and end-stage renal disease","volume":"19","author":"Rogula","year":"2022","journal-title":"Int J Environ Res Public Health [Internet]."},{"key":"2026012110521323300_CR5","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1016\/j.jacc.2019.08.1031","article-title":"Anticoagulation in concomitant chronic kidney disease and atrial fibrillation: JACC review topic of the week","volume":"74","author":"Kumar","year":"2019","journal-title":"J Am Coll Cardiol [Internet]"},{"key":"2026012110521323300_CR6","article-title":"Has the introduction of direct oral anticoagulants (DOACs) in England increased emergency admissions for bleeding conditions? 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June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 September 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"This meta-analysis did not require ethical approval as it involved secondary data analysis. All included studies had obtained ethical approval from their respective IRBs.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This meta-analysis exclusively synthesizes data from previously published studies involving human participants or animal subjects. No new human or animal research was conducted as part of this analysis. The original studies included in this review were required to comply with ethical standards as per the Declaration of Helsinki for human research or institutional animal care guidelines for animal studies. We assume that all studies analyzed received appropriate ethical approval from their respective institutional review boards or animal care and use committees.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Animal and human rights"}},{"value":"No new data were collected. Informed consent was obtained in all original studies included in this meta-analysis.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent to participate"}}]}}