Why the study?
Does apixaban reduce major bleeding compared to warfarin in patients with advanced chronic kidney disease?
Does apixaban reduce major bleeding compared to warfarin in patients with advanced chronic kidney disease?
In patients with advanced CKD, apixaban is associated with significantly lower major bleeding rates between 6 and 12 months compared to warfarin, without increasing the risk of ischemic stroke or recurrent VTE.
Apixaban may be associated with lower bleeding in advanced CKD; leaves open need for randomized confirmation before practice change.
A total of 604 patients were included in the analysis. The percentage of apixaban and warfarin patients with a major bleed at 0 to 3, 3 to 6, and 6 to 12 months were 8.3% versus 9.9% ( P=0.48), 1.4% versus 4% ( P=0.07), and 1.5% versus 8.4% ( P<0.001), respectively. There were no differences in rates of ischemic stroke or recurrent VTE at any time period. Conclusion and Relevance: Patients with advanced CKD taking apixaban had similar bleeding rates at 3 months compared with those taking warfarin. However, those who continued therapy had higher major bleeding rates with warfarin between 6 and 12 months. This study provides knowledge on the effects of a direct oral anticoagulant in a population that was excluded from all major trials.
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Schafer et al. (2018) studied this question.
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