만성신장병환자에서 apixaban과 warfarin의 안전성 비교: 체계적 문헌고찰 및 메타분석

다국어 초록 (Multilingual Abstract)

Background: Patients with chronic kidney disease (CKD) are at a high risk of stroke-related morbidity, mortality, and bleeding. However, the overall risk/benefit of anticoagulant therapy among patients with CKD remains unclear. Methods: The MEDLINE, EMBASE, and CENTRAL databases were comprehensively searched until July 31, 2020, to investigate the safety and efficacy of apixaban in patients with stage 4 or 5 CKD, as compared with warfarin. The primary outcome was an incidence of major bleeding. Secondary outcomes included composite bleeding (major, clinically relevant, and minor bleeding), venous thromboembolism (VTE), stroke, and death. Results: In total, seven studies consisting of 10,816 patients were included. Compared with warfarin, apixaban was associated with a reduced risk of major bleeding (OR 0.49, 95% CI 0.41-0.58). In terms of composite bleeding, apixaban tended to pose a significantly lower risk than warfarin (OR 0.51, 95% CI 0.37-0.71). There was no difference between apixaban and warfarin with respect to the risk of stroke or death (stroke: OR 1.23, 95% CI 0.49-3.12; death: OR 0.73, 95% CI 0.45- 1.18). Conclusion: Among patients with stage 4 or 5 CKD, the use of apixaban was associated with a lower risk of bleeding compared to warfarin and was also found to pose no excess risk of thromboembolic events.

목차 (Table of Contents)

• ABSTRACT
• 연구 방법
• 문헌 검색
• 문헌 선택
• 자료 추출
• 비뚤림 평가
• 자료의 통합 및 분석
• 연구 결과
• 문헌 선택 결과
• 체계적 문헌고찰 대상문헌들의 개별적 특성
• Major bleeding 발생률
• Composite bleeding 발생률
• Stroke 및 VTE 발생률
• 사망률
• 선정 문헌의 비뚤림 위험 평가
• 고찰
• 결론
• 감사의 말씀
• 이해상충
• 참고문헌