We read with great interest the systematic review and meta-analysis by Kyriakoulis et al. comparing direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) in patients with atrial fibrillation and end-stage renal disease requiring hemodialysis [1]. The authors summarized the current evidence from three randomized controlled trials (RCTs) and three observational studies that included over 20,000 patients. In this meta-analysis, Kyriakoulis et al. [1] found no significant differences in the risk of ischemic stroke (risk ratio [RR] 0.76), composite outcome of ischemic stroke or systemic embolism (RR, 0.65), major bleeding (RR, 0.79), minor bleeding (RR, 0.92), or all-cause mortality (RR, 0.79) between DOACs and VKAs.
