Journal article
Safety and efficacy of apixaban versus warfarin in patients with end-stage renal disease: Meta-analysis
Pacing and clinical electrophysiology, Vol.41(6), pp.627-634
06/01/2018
DOI: 10.1111/pace.13331
PMID: 29577340
Abstract
BackgroundAt the present, apixaban is the only nonvitamin K oral anticoagulant approved by the Food and Drug Administration for use with patients with creatinine clearance<15mL/min or end-stage renal disease (ESRD). However, the recommendations are based on pharmacokinetic and pharmacodynamic data and there was lack of clinical trial evidence. We aimed to assess safety and efficacy of apixaban in patients with advanced chronic kidney disease (CKD) or ESRD.
MethodsDatabases were searched through November 2017. Studies that reported incidence or odd ratios of bleeding complications or thromboembolic events in the use of apixaban in patients with CKD stage 4-5 or ESRD on dialysis were included. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird.
ResultsFive studies were included into the analysis consisting of 43,850 patients in observational cohort studies. The majority of patients (87%) used apixaban for atrial fibrillation. The pooled estimated incidence of any bleeding complications on apixaban was 17.4% (95% confidence interval [CI]: 13.0%-23.0%). Compared to warfarin, apixaban was significantly associated with reduced risk of major bleeding (pooled odds ratio [OR], 0.42; 95% CI, 0.28-0.61). In studies in ESRD patients on dialysis, the pooled OR of major bleeding was 0.27 (95% CI, 0.07-0.95). There was no significant difference in risk of thromboembolic events in advanced CKD or ESRD patients on apixaban versus vitamin K antagonists (pooled OR, 0.56; 95% CI, 0.23-1.39).
ConclusionsAmong patients with advanced CKD and ESRD, the use of apixaban was associated with lower risk of major bleeding compared to warfarin, and was found to be relatively effective with no excess risk of thromboembolic events.
Details
- Title: Subtitle
- Safety and efficacy of apixaban versus warfarin in patients with end-stage renal disease: Meta-analysis
- Creators
- Ronpichai Chokesuwattanaskul - King Chulalongkorn Memorial HospitalCharat Thongprayoon - Bassett Medical CenterTanyanan Tanawuttiwat - University of Mississippi Medical CenterWisit Kaewput - Phramongkutklao HospitalPavida Pachariyanon - Texas Tech University Health Sciences CenterWisit Cheungpasitporn - University of Mississippi Medical Center
- Resource Type
- Journal article
- Publication Details
- Pacing and clinical electrophysiology, Vol.41(6), pp.627-634
- Publisher
- Wiley
- DOI
- 10.1111/pace.13331
- PMID
- 29577340
- ISSN
- 0147-8389
- eISSN
- 1540-8159
- Number of pages
- 8
- Language
- English
- Date published
- 06/01/2018
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984694748602771
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