Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
October 18, 2021Frontiers in Cardiovascular MedicineOpen Access

Apixaban significantly reduced the risk of stroke or systemic embolism by 26% (aHR 0.74) compared to warfarin in patients with atrial fibrillation and chronic kidney disease.

View Full Paper
Ask AI
Bookmark
Share

Why the study?

Real-world evidence of apixaban treatment in patients with chronic kidney disease remains scarce.

Does apixaban reduce the risk of stroke or systemic embolism and major bleeding compared to warfarin in atrial fibrillation patients with chronic kidney disease?

Comparison

Apixaban vs warfarin

Design

Propensity-score matched retrospective cohort study

Key result

Apixaban significantly reduced the risk of stroke or systemic embolism by 26% (aHR 0.74) compared to warfarin in patients with atrial fibrillation and chronic kidney disease.

Authors

CFChung-Ming FuLLLung‐Chih LiYLYueh‐Ting Lee

Discussion

Loading...

Member takes

Overview

Apixaban may lower stroke/SE risk versus warfarin in this cohort; extends low-certainty observational evidence but should not change practice.

Key Points

  • The study compares the risk of stroke/systemic embolism and major bleeding between apixaban and warfarin in atrial fibrillation patients with chronic kidney disease.
  • Evaluated newly diagnosed atrial fibrillation patients (2004-2018) from a healthcare network in Taiwan.
  • Propensity-score matched cohorts compared hospitalization outcomes for stroke/systemic embolism and major bleeding.
  • Stratified analyses based on initial apixaban doses (10 mg/day vs. 2.5-5.0 mg/day) and baseline eGFR.
  • Apixaban was associated with a lower risk of stroke/systemic embolism (aHR: 0.74; 95% CI:0.57–0.97; p = 0.03).
  • Major bleeding risk was lower for standard doses of apixaban compared to warfarin (aHR: 0.66; 95% CI: 0.45–0.96; p = 0.03).
  • In patients with eGFR <30 ml/min/1.73 m2, apixaban reduced stroke/systemic embolism risk by 37% (aHR: 0.63; 95% CI: 0.40–0.98; p = 0.04).

Study Design

Type

Cohort (n=3,250)

Multicenter

Yes

Structured PICO

Does apixaban reduce the risk of stroke or systemic embolism and major bleeding compared to warfarin in atrial fibrillation patients with chronic kidney disease?

P
Population
3,250 propensity-score matched adult patients with atrial fibrillation and chronic kidney disease, treated with apixaban or warfarin, evaluated retrospectively for stroke and bleeding outcomes.
E
Exposure
Apixaban (standard dose of 10 mg/day or reduced dose of 2.5-5.0 mg/day)
C
Comparator
Warfarin
O
Outcome
Hospitalization for stroke or systemic embolism (SE)hard clinical

Main Result

Hazard Ratio: 0.74 (95% CI 0.57–0.97)

Absolute Event Rate: 7.08% vs 10.77%

p-value: p=0.03

In a real-world Taiwanese cohort of atrial fibrillation patients, apixaban was associated with a significantly lower risk of stroke or systemic embolism compared to warfarin, including in patients with advanced chronic kidney disease.

Limitations

  • Retrospective observational design may be subject to residual confounding.
  • High proportion of patients received reduced-dose apixaban, which may reflect specific Asian population characteristics.
  • Results may have limited generalizability outside of Taiwanese or Asian populations.
  • Kidney function was estimated using the Taiwan version of the MDRD formula, which may differ from creatinine clearance used in other trials.
  • Biases due to residual confounding may not have been eliminated
  • High proportion of patients who received reduced-dose apixaban
  • Results may be applicable only in Taiwanese or Asian populations and have limited generalizability to the overall population of CKD patients
  • MDRD-based eGFR values could be not the same as CrCl

Cite This Study

Fu et al. (2021) conducted a cohort in Atrial fibrillation with chronic kidney disease (n=3,250). Apixaban vs. Warfarin was evaluated on Stroke or systemic embolism (aHR 0.74, 95% CI 0.57-0.97, p=0.03). Apixaban significantly reduced the risk of stroke or systemic embolism by 26% (aHR 0.74) compared to warfarin in patients with atrial fibrillation and chronic kidney disease.

synapsesocial.com/papers/6a3300e75fe356619419ebd3https://doi.org/10.3389/fcvm.2021.752468
View Full Paper
Ask AI
Bookmark
Share