{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T20:38:35Z","timestamp":1793306315128,"version":"4.5.0"},"reference-count":50,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T00:00:00Z","timestamp":1688688000000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,6,16]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Chronic kidney disease (CKD) and atrial fibrillation (AF) are increasing in prevalence globally and share common risk factors.<\/jats:p>\n                  <jats:p>Our aim was to characterise real-world evidence on direct oral anticoagulant (DOAC) prescribing for people with AF and CKD, in terms of adherence, persistence and renal dose titration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>PubMed, EMBASE and CINAHL were searched from inception to June 2022. Our search terms included a combination of Medical Subject Headings (MeSH) terms and keywords including \u2018atrial fibrillation\u2019, \u2018chronic kidney disease\u2019, \u2018adherence\u2019, \u2018persistence\u2019, \u2018direct oral anticoagulants\u2019 and \u2018dosing\u2019. Data extraction and quality assessment were undertaken by two reviewers independently. Meta-analyses for pooled estimates were performed using DerSimonian and Laird random-effects models. Age, sex, diabetes, hypertension and heart failure were chosen as variables of interest.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From 19 studies, a total of 252\u2009117 patients were included with CKD and AF. Meta-analysis was only possible in seven studies with 128\u2009406 patients, five on DOAC dose titration and two on adherence. There were insufficient studies on persistence. Our meta-analysis of dosing showed that 68% of patients with CKD and AF had correct dosing. There was no evidence to show any association between correct DOAC dosing and variables of interest. Overall, 67% of patients were DOAC adherent.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Adherence and correct dosing of DOACs were suboptimal compared with other medications in the pooled studies with respect to CKD and AF. Thus, further research is required as the lack of generalisation of findings is a rate-limiting factor for improved DOAC management in AF and CKD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD;42022344491.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002340","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T02:00:32Z","timestamp":1688695232000},"page":"e002340","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Correct dosing, adherence and persistence of DOACs in atrial fibrillation and chronic kidney disease: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9049-5179","authenticated-orcid":false,"given":"Subo","family":"Emanuel","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riyaz A","family":"Kaba","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Academic Group,Molecular and Clinical Sciences Institute, University of London and St George's University Hospitals NHS Foundation Trust, London, UK"},{"name":"Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK"},{"name":"Department of Biological Sciences, Royal Holloway, University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayathri","family":"Delanerolle","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"Southern Health NHS Foundation Trust, Winchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1883-1588","authenticated-orcid":false,"given":"Benjamin C T","family":"Field","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK"},{"name":"Department of Diabetes and Endocrinology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK"},{"name":"Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8553-2641","authenticated-orcid":false,"given":"Simon","family":"de Lusignan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"Royal College of General Practitioners, Research and Surveillance Centre, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,6]]},"reference":[{"key":"2025081710060680000_10.2.e002340.1","doi-asserted-by":"crossref","DOI":"10.1155\/2022\/6707985","article-title":"Time trends and treatment pathways in prescribing individual oral anticoagulants in patients with nonvalvular atrial fibrillation: an observational study of more than three million patients from Europe and the United States","volume":"2022","author":"Vora","year":"2022","journal-title":"Int J Clin Pract"},{"key":"2025081710060680000_10.2.e002340.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62343-0"},{"key":"2025081710060680000_10.2.e002340.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"2025081710060680000_10.2.e002340.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310907"},{"key":"2025081710060680000_10.2.e002340.5","unstructured":"NICE . 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