Apixaban versus Warfarin in Patients with Chronic Kidney Disease; A Systematic Review and Meta-analysis
10.24304/kjcp.2021.31.2.87
- Author:
Jae Hyun NAM
1
;
Chae Young KIM
;
Yoo Kyung LEE
;
Da Woom JUNG
;
Hye Young GWAK
;
Jee Eun CHUNG
Author Information
1. College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggido 15588, Republic of Korea
- Publication Type:Review Article
- From:Korean Journal of Clinical Pharmacy
2021;31(2):87-95
- CountryRepublic of Korea
- Language:English
-
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.
