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

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Abstract

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.

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Authors and Affiliations

  1. Department of Internal Medicine-Pediatrics, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA, 92354, USA

    Michael Bowie

  2. Department of Pharmacy, Children’s Hospital of Orange County, 1201 West La Veta Ave, Orange, CA, 92868, USA

    Violet Valencia

  3. Department of Pathology and Laboratory Medicine, University of California, Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868, USA

    Ingrid Perez-Alvarez & Minh-Ha Tran

Authors
  1. Michael Bowie
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  2. Violet Valencia
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  3. Ingrid Perez-Alvarez
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  4. Minh-Ha Tran
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Correspondence to Michael Bowie.

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Bowie, M., Valencia, V., Perez-Alvarez, I. et al. Safety analysis of apixaban versus warfarin in patients with advanced kidney disease. J Thromb Thrombolysis 46, 246–252 (2018). https://doi.org/10.1007/s11239-018-1683-5

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  • DOI: https://doi.org/10.1007/s11239-018-1683-5

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