Outcomes associated with apixaban vs warfarin in patients with renal dysfunction

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Limited data exists on apixaban use in patients with severe renal impairment (creatinine clearance [CrCl] <25 mL/min).
• Major clinical trials excluded patients with CrCl <25 mL/min, leaving a gap in understanding apixaban's safety and efficacy in this population.

Purpose of the Study:

• To evaluate the safety and effectiveness of apixaban compared to warfarin in patients with CrCl <25 mL/min.
• To assess thrombosis and bleeding outcomes in patients with severe renal dysfunction receiving apixaban or warfarin.

Main Methods:

• A multicenter, retrospective chart review of patients newly initiated on apixaban or warfarin with CrCl <25 mL/min.
• Evaluation of thrombosis and bleeding events over a 6-month period post-anticoagulation initiation.
• Statistical analysis using Cox proportional hazards model to control for confounding factors.

Main Results:

• The study included 128 patients on apixaban and 733 on warfarin.
• After controlling for atrial fibrillation and coronary artery bypass grafting, apixaban showed a lower risk of thrombotic and bleeding events (hazard ratio, 0.47).
• No statistical difference was observed in the time to thrombosis, rate of thrombosis, time to bleeding, or rate of bleeding between the groups.

Conclusions:

• Apixaban may be a reasonable alternative to warfarin for patients with severe renal dysfunction.
• Further research is warranted to confirm these findings in a broader patient population with severe renal impairment.