Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Apixaban versus Warfarin in Patients with Chronic Kidney Disease; A Systematic Review and Meta-analysis

만성신장병환자에서 apixaban과 warfarin의 안전성 비교: 체계적 문헌고찰 및 메타분석

  • Nam, Jae Hyun (College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University) ;
  • Kim, Chae Young (College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University) ;
  • Lee, Yoo Kyung (College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University) ;
  • Jung, Da Woom (College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University) ;
  • Gwak, Hye Young (Department of Pharmacy, Hanyang University Hospital) ;
  • Chung, Jee Eun (College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University)
  • Received : 2021.04.28
  • Accepted : 2021.06.10
  • Published : 2021.06.30
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Abstract

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.

Keywords

Acknowledgement

본 연구는 한국연구재단(과제번호: NRF-2018R1D1A1B07049959) 및 과학기술정보통신부 정보통신기획평가단(과제번호: 2020-0-01343, 인공지능융합센터, 한양대학교 ERICA) 지원을 받아 수행되었으므로 이에 감사드립니다.

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