Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 2, pp 246–252 | Cite as

Safety analysis of apixaban versus warfarin in patients with advanced kidney disease

  • Michael Bowie
  • Violet Valencia
  • Ingrid Perez-Alvarez
  • Minh-Ha Tran


Anticoagulation in patients with advanced kidney disease, defined as those with an eGFR < 25 mL/min, including patients with end-stage renal disease on hemodialysis, remains an area of controversy and debate. Due to safety concerns regarding the increased risk for bleeding in this population, these patients have been excluded from all large-scale, randomized controlled trials to date. Warfarin and apixaban are both FDA-approved for use in this population and although warfarin remains the anticoagulant of choice, apixaban use is steadily increasing. This review combines relevant literature to better understand the risk versus benefit of anticoagulation in patients with severe kidney disease as well as the safety of apixaban versus warfarin in this population. High rates of bleed were found among both anticoagulants in those with severe kidney disease, suggesting that the risk for bleed associated with anticoagulation may not outweigh the benefit of treatment. Apixaban was found to be superior in rates of major bleed in those with ESRD on HD and may be superior to warfarin in those with an eGFR < 25 mL/min. However, large-scale, randomized clinical trials are needed to validate these results. With the continued development of novel agents there may be superior alternatives to apixaban and warfarin in those with severe kidney disease in the future.


Apixaban Warfarin Anticoagulation Renal insufficiency End-stage renal disease Hemodialysis 


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Michael Bowie
    • 1
  • Violet Valencia
    • 2
  • Ingrid Perez-Alvarez
    • 3
  • Minh-Ha Tran
    • 3
  1. 1.Department of Internal Medicine-PediatricsLoma Linda University Medical CenterLoma LindaUSA
  2. 2.Department of PharmacyChildren’s Hospital of Orange CountyOrangeUSA
  3. 3.Department of Pathology and Laboratory MedicineUniversity of California, Irvine Medical CenterOrangeUSA

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