Accepted Manuscript Meta-analysis of the Influence of Chronic Kidney Disease on the Risk of Thromboembolism Among Patients with Non-valvular Atrial Fibrillation Rui Providência , MD, MSc Eloi Marijon , MD, PhD Serge Boveda , MD Sérgio Barra , MD Kumar Narayanan , MD Jean-Yves Le Heuzey , MD Bernard J. Gersh , MB ChB, DPhil Lino Gonçalves , MD, PhD PII:
S0002-9149(14)01241-7
DOI:
10.1016/j.amjcard.2014.05.048
Reference:
AJC 20507
To appear in:
The American Journal of Cardiology
Received Date: 9 April 2014 Revised Date:
25 May 2014
Accepted Date: 27 May 2014
Please cite this article as: Providência R, Marijon E, Boveda S, Barra S, Narayanan K, Le Heuzey J-Y, Gersh BJ, Gonçalves L, Meta-analysis of the Influence of Chronic Kidney Disease on the Risk of Thromboembolism Among Patients with Non-valvular Atrial Fibrillation, The American Journal of Cardiology (2014), doi: 10.1016/j.amjcard.2014.05.048. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Meta-analysis of the Influence of Chronic Kidney Disease on the Risk of Thromboembolism Among Patients with Non-valvular Atrial Fibrillation (a, b)
(c)
(a)
(d)
Rui Providência, MD MSc , Eloi Marijon MD PhD , Serge Boveda, MD , Sérgio Barra, MD , Kumar (c, e) (c) (f) (b) Narayanan MD , Jean-Yves Le Heuzey MD , Bernard J Gersh MB ChB DPhil , Lino Gonçalves, MD PhD a
Département de Rythmologie, Clinique Pasteur, Toulouse, France Faculty of Medicine, University of Coimbra, Coimbra, Portugal c Paris Descartes University and European Georges Pompidou Hospital, Paris, France d Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom e Heart Institute, Cedars Sinai Medical Center, Los Angeles, USA f Mayo Clinic, Rochester, Minnesota, USA
SC
RI PT
b
Corresponding author: Rui Providência e-mail: [email protected]
M AN U
Short Title: CKD and Thromboembolism in AF
Clinique Pasteur - Département de Rythmologie 45 avenue de Lombez
TE D
BP 27617 31076 Toulouse Cedex 3
EP
France
Telephone number: +33 5 62 21 16 45
AC C
Fax: +33 5 62 21 16 41
Original Article – American Journal of Cardiology Conflicts of Interest: none
1
ACCEPTED MANUSCRIPT Abstract Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist. However, the extent to which CKD increases the risk of thromboembolism among patients with non-valvular AF, as well as
RI PT
the benefits of anticoagulation in this group remain unclear. We addressed the role of CKD in the prediction of thromboembolic events and the impact of anticoagulation using a meta-analysis methodology. Data sources included MEDLINE, EMBASE and COCHRANE (from inception to January 2014). Three independent reviewers selected studies. Descriptive and quantitative information was
SC
extracted from each selected study and a random-effects meta-analysis was performed. After screening 962 search results, 19 studies were considered eligible. Among patients with AF, the
M AN U
presence of CKD resulted in an increased risk of thromboembolism (HR = 1.46; 95%CI 1.20-1.76, P=0.0001), particularly in case of endstage CKD (HR = 1.83; 95%CI 1.56-2.14, P
S0002-9149(14)01241-7
DOI:
10.1016/j.amjcard.2014.05.048
Reference:
AJC 20507
To appear in:
The American Journal of Cardiology
Received Date: 9 April 2014 Revised Date:
25 May 2014
Accepted Date: 27 May 2014
Please cite this article as: Providência R, Marijon E, Boveda S, Barra S, Narayanan K, Le Heuzey J-Y, Gersh BJ, Gonçalves L, Meta-analysis of the Influence of Chronic Kidney Disease on the Risk of Thromboembolism Among Patients with Non-valvular Atrial Fibrillation, The American Journal of Cardiology (2014), doi: 10.1016/j.amjcard.2014.05.048. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Meta-analysis of the Influence of Chronic Kidney Disease on the Risk of Thromboembolism Among Patients with Non-valvular Atrial Fibrillation (a, b)
(c)
(a)
(d)
Rui Providência, MD MSc , Eloi Marijon MD PhD , Serge Boveda, MD , Sérgio Barra, MD , Kumar (c, e) (c) (f) (b) Narayanan MD , Jean-Yves Le Heuzey MD , Bernard J Gersh MB ChB DPhil , Lino Gonçalves, MD PhD a
Département de Rythmologie, Clinique Pasteur, Toulouse, France Faculty of Medicine, University of Coimbra, Coimbra, Portugal c Paris Descartes University and European Georges Pompidou Hospital, Paris, France d Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom e Heart Institute, Cedars Sinai Medical Center, Los Angeles, USA f Mayo Clinic, Rochester, Minnesota, USA
SC
RI PT
b
Corresponding author: Rui Providência e-mail: [email protected]
M AN U
Short Title: CKD and Thromboembolism in AF
Clinique Pasteur - Département de Rythmologie 45 avenue de Lombez
TE D
BP 27617 31076 Toulouse Cedex 3
EP
France
Telephone number: +33 5 62 21 16 45
AC C
Fax: +33 5 62 21 16 41
Original Article – American Journal of Cardiology Conflicts of Interest: none
1
ACCEPTED MANUSCRIPT Abstract Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist. However, the extent to which CKD increases the risk of thromboembolism among patients with non-valvular AF, as well as
RI PT
the benefits of anticoagulation in this group remain unclear. We addressed the role of CKD in the prediction of thromboembolic events and the impact of anticoagulation using a meta-analysis methodology. Data sources included MEDLINE, EMBASE and COCHRANE (from inception to January 2014). Three independent reviewers selected studies. Descriptive and quantitative information was
SC
extracted from each selected study and a random-effects meta-analysis was performed. After screening 962 search results, 19 studies were considered eligible. Among patients with AF, the
M AN U
presence of CKD resulted in an increased risk of thromboembolism (HR = 1.46; 95%CI 1.20-1.76, P=0.0001), particularly in case of endstage CKD (HR = 1.83; 95%CI 1.56-2.14, P
