Key result
Apixaban for AF in stage 4-5 CKD or hemodialysis is linked to ~31% bleeding incidence.
Why the study?
DOACs have varied degrees of renal clearance, and their safety and effectiveness in end-stage renal disease remain uncertain.
Observational (n=39)
No
In patients with advanced CKD or on hemodialysis, apixaban use for atrial fibrillation is associated with a high incidence of bleeding (31%), predominantly major bleeding.
High bleeding incidence supports caution with apixaban in advanced CKD or hemodialysis; leaves open randomized comparisons of dosing and alternatives.
Background: Chronic kidney disease (CKD) is known to increase the thromboembolic risk among patients with nonvalvular atrial fibrillation (NVAF). NVAF has been associated with poor outcomes in patients with CKD or hemodialysis (HD). Direct oral anticoagulants (DOACs) have varied degrees of renal clearance and their safety and effectiveness in end-stage renal disease (ESRD) is uncertain. This study aimed to estimate the incidence of bleeding events in patients with stage 4–5 CKD or HD receiving Apixaban for NVAF. Materials and Methods: This was an observational, retrospective study conducted at a tertiary care hospital in Riyadh, Saudi Arabia between 2017 and 2020. Patients ≥18 years old with CKD stage 4–5 or HD receiving Apixaban for AF were included. The primary endpoint of the study was to determine the incidence of bleeding in patients receiving Apixaban for stroke prevention. Secondary outcome included the factors associated with increasing the odds of experiencing bleeding events. Results: A total of 39 patients consisting of 17 males and 22 females were included in our study. The mean age of subjects was 79 ± 7 years. Approximately 80% of the patients were receiving Apixaban 2.5 mg twice daily. In addition to Apixaban, 33% were concomitantly taking Aspirin and/or Clopidogrel where 9% ( n = 4) of them had bleeding. Approximately 51% of the patients had CKD stage 4. Overall, the incidence of bleeding among patients with CKD receiving Apixaban for AF was 31%. Of these, 91.7% had experienced major bleeding. Men were less likely to develop bleeding than women. Moreover, those with CKD stage 4 were less likely to develop bleeding compared with patients with CKD stage 5. No statistical difference was observed between Apixaban 2.5 mg and 5 mg in terms of bleeding risk. Conclusion: Our findings suggest that nearly a third of our CKD sample developed some sort of bleeding episodes while taking Apixaban to prevent stroke. Further large studies are warranted to confirm our findings.
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Alsalmi et al. (2023) conducted an observational in Nonvalvular atrial fibrillation with advanced chronic kidney disease (n=39). Apixaban was evaluated on Incidence of bleeding. Among patients with stage 4-5 chronic kidney disease or hemodialysis receiving apixaban for atrial fibrillation, the overall incidence of bleeding was 31%.
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