Direct oral anticoagulants versus vitamin K antagonists for atrial fibrillation patients on dialysis: A systematic review and meta-analysis of randomized controlled trials and real-world evidence.

Omar Shaheen, Mohamed Hamdy, Ibrahem Attiya Afifi, Abdelrahman Ahmed Hassan, Omar Kassar, Ahmed Ismail, Samer Sameh Bedwany, Badria Atef Ebrahim Elhalawany, Rehab Adel Diab

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Review in Journal of thrombosis and thrombolysis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Omar ShaheenFaculty of Medicine, Alexandria University, Alexandria, Egypt. omarshahin11902@gmail.com.ORCID http://orcid.org/0009-0005-2874-2641

Mohamed HamdyFaculty of Medicine, Cairo University, Cairo, Egypt.ORCID http://orcid.org/0009-0004-4033-6884

Ibrahem Attiya AfifiFaculty of Medicine, Al-Azhar University, Cairo, Egypt.ORCID http://orcid.org/0009-0003-2941-5816

Abdelrahman Ahmed HassanFaculty of Medicine, Cairo University, Cairo, Egypt.ORCID http://orcid.org/0009-0005-1108-6764

Omar KassarFaculty of Medicine, Alexandria University, Alexandria, Egypt.ORCID http://orcid.org/0009-0009-9203-5107

Ahmed IsmailFaculty of Medicine, Minia university, Minia, Egypt.ORCID http://orcid.org/0009-0002-9431-5259

Samer Sameh BedwanyFaculty of Medicine, Sohag University, Sohag, Egypt.ORCID http://orcid.org/0009-0009-3647-5044

Badria Atef Ebrahim ElhalawanyCardiology department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Rehab Adel DiabCardiology department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.ORCID http://orcid.org/0000-0002-6552-4900

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in end-stage renal disease (ESRD) patients on dialysis. These patients face high risks of both thromboembolism and bleeding. Pivotal randomized controlled trials (RCTs) of direct oral anticoagulants (DOACs) excluded these patients, leaving the optimal anticoagulant choice uncertain. We conducted a systematic review and meta-analysis investigating the efficacy and safety of DOACs versus VKAs in AF patients undergoing dialysis. We searched PubMed, Scopus, Web of Science, and Cochrane Library for RCTs and observational studies. Primary outcomes were ischemic stroke, major bleeding, and all-cause mortality. Secondary outcomes included ischemic stroke or systemic embolism, other bleeding events, hemorrhagic stroke, myocardial infarction, and cardiovascular mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Four RCTs and nine observational studies were included in this study, encompassing 31,238 patients. DOACs were associated with significantly lower risk of major bleeding (RR: 0.68, 95% CI [0.49-0.95], I

Indexed as

Atrial fibrillation; End-stage renal diseaseDirect oral anticoagulantsVitamin K antagonists

Identifiers

PMID42177744

DOI10.1177/10760296241271423

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.