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http://dx.doi.org/10.24304/kjcp.2021.31.2.87

Apixaban versus Warfarin in Patients with Chronic Kidney Disease; A Systematic Review and Meta-analysis  

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)
Publication Information
Korean Journal of Clinical Pharmacy / v.31, no.2, 2021 , pp. 87-95 More about this Journal
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
Chronic kidney disease; apixaban; warfarin; bleeding; thromboembolism;
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