Safety analysis of apixaban versus warfarin in patients with advanced kidney disease
- 557 Downloads
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.
KeywordsApixaban Warfarin Anticoagulation Renal insufficiency End-stage renal disease Hemodialysis
- 16.Pelliccia F, Rosanio S, Marazzi G et al (2016) Efficacy and safety of novel anticoagulants versus vitamin K antagonists in patients with mild and moderate to severe renal insufficiency: focus on apixaban. Int J Cardiol 225:77–81. https://doi.org/10.1016/jijcard.2016.09.129 CrossRefPubMedGoogle Scholar
- 19.Skelley J, Thomason A, Nolen J (2018) Betrixaban (Bevyxxa) A direct-acting oral anticoagulant factor Xa inhibitor. Pharm Ther 43(2):85–88Google Scholar
- 21.Steuber T, Shiltz D, Cairns A, Ding Q, Binger K, Courtney J (2017) A multicenter analysis of factors associated with apixaban-related bleeding in hospitalized patients with end-stage renal disease of hemodialysis. Ann Pharmacother 51(11):954–960. https://doi.org/10.1177/1060028017717282 CrossRefPubMedGoogle Scholar