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KMID : 0941820210310020087
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Korean Journal of Clinical Pharmacy
2021 Volume.31 No. 2 p.87 ~ p.95
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Apixaban versus Warfarin in Patients with Chronic Kidney Disease; A Systematic Review and Meta-analysis
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Nam Jae-Hyun
Kim Chae-Young
Lee Yoo-Kyung
Jung Da-Woom
Gwak Hye-Young
Chung Jee-Eun
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Abstract
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Background: Patients with chronic kidney disease (CKD) are at a high risk of stroke-related morbidity, mortality, and bleeding. However, the overall risk/benefit of anticoagulant therapy among patients with CKD remains unclear.
Methods: The MEDLINE, EMBASE, and CENTRAL databases were comprehensively searched until July 31, 2020, to investigate the safety and efficacy of apixaban in patients with stage 4 or 5 CKD, as compared with warfarin. The primary outcome was an incidence of major bleeding. Secondary outcomes included composite bleeding (major, clinically relevant, and minor bleeding), venous thromboembolism (VTE), stroke, and death.
Results: In total, seven studies consisting of 10,816 patients were included. Compared with warfarin, apixaban was associated with a reduced risk of major bleeding (OR 0.49, 95% CI 0.41-0.58). In terms of composite bleeding, apixaban tended to pose a significantly lower risk than warfarin (OR 0.51, 95% CI 0.37-0.71). There was no difference between apixaban and warfarin with respect to the risk of stroke or death (stroke: OR 1.23, 95% CI 0.49-3.12; death: OR 0.73, 95% CI 0.45-1.18).
Conclusion: Among patients with stage 4 or 5 CKD, the use of apixaban was associated with a lower risk of bleeding compared to warfarin and was also found to pose no excess risk of thromboembolic events.
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KEYWORD
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Chronic kidney disease, apixaban, warfarin, bleeding, thromboembolism
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