Comparison of the Safety and Effectiveness of Apixaban versus Warfarin in Patients with Severe Renal Impairment: An Alternative Viewpoint

Roberts, Megan Z.; Farley, Thomas M.; Owens, Ryan E.

doi:10.1002/phar.1993

Cited by 1 publication

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“…The question regarding safe dosing of apixaban in ESRD patients on dialysis has been asked in response to Stanton et al. analysis . The majority of patients on apixaban in our analysis were taking the recommended dose of 5 mg every 12 hours.…”

Section: Discussionmentioning

confidence: 99%

Safety and effectiveness of apixaban compared to warfarin in dialysis patients

Reed

Palkimas

Hockman

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials The safety of apixaban in patients on dialysis is currently debated.Bleeding events were retrospectively compared for dialysis patients on warfarin vs apixaban.Overall bleeding events were significantly less frequent in apixaban group compared to warfarin group.Apixaban appears to be a safe and effective choice for anticoagulation in patients on dialysis. BackgroundThe use of apixaban for stroke prophylaxis or for the treatment of venous thromboembolism in end stage renal disease (ESRD) patients maintained on dialysis is based on one single‐dose pharmacokinetic study. There is a deficiency of clinical evidence supporting safety in this population.ObjectiveThe purpose of this study was to determine the safety and efficacy of apixaban compared with warfarin in dialysis patients.Patients/methodsThis is a retrospective cohort study conducted at the University of Virginia Medical Center. A total of 124 ESRD patients maintained on dialysis who either received apixaban (n = 74) or warfarin (n = 50) between January 1, 2014 and October 31, 2016 were included in the study. We used multivariable logistic regression to compare the likelihood of patients experiencing a bleeding event based on anticoagulant therapy.ResultsThe apixaban group experienced fewer overall bleeding events than the warfarin group (18.9% vs 42.0%; P = .01); this significant difference persisted in adjusted analysis (OR = 0.15; 95% CI = 0.05‐0.46; P = .001). Major bleeding events were less frequent in the apixaban group compared with patients on warfarin (5.4% vs 22.0%; P = .01). There were no recurrent ischemic strokes in either groups. A lower, non‐significant, incidence of recurrent VTE was found in patients on apixaban compared with warfarin (4.4% vs 28.6%; P = .99).ConclusionCompared to warfarin, our findings suggest that apixaban is a safe and effective alternative in patients with ESRD maintained on dialysis, with apixaban patients experiencing fewer bleeding events than warfarin patients.

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Section: Discussionmentioning

confidence: 99%