Details

Autor(en) / Beteiligte

• Zagoridis, Konstantinos
• Karatisidis, Lazaros
• Mprotsis, Theodoros
• Pentidou, Aikaterini
• Bezirgianidou, Zoi
• Misidou, Christina
• Spanoudakis, Emmanouil

Titel

Apixaban reduces the risk of major and clinically relevant non-major bleeding compared to warfarin in patients with end stage renal disease; a systematic review and meta-analysis of ten studies

Ist Teil von

• Thrombosis research, 2023-11, Vol.231, p.17-24

Ort / Verlag

Elsevier Ltd

Erscheinungsjahr

2023

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Optimal anticoagulation in patients with end-stage renal disease ESRD is a matter of debate since these patients are not included in randomized controlled trials (RCTs). Evolving data are in favor of apixaban compared to warfarin. We extracted data from 2 RCTs, 5 retrospective cohort studies and 3 large data-based studies. Both dosing regimens of apixaban, standard or reduced, were accepted. In most studies characteristics of patients were balanced between arms. Patients with either atrial fibrillation (AF) or venous thromboembolism (VTE) were included. Quality of studies was graded as high and the funnel plot did not detect any publication bias. In total we analyzed the outcome of 6693 ESRD patients treated with apixaban and 19,836 treated with warfarin. Our analysis was performed by using the random effects model. We report our data as Risk Ratio (RR) and associated 95 % confidence interval values (95 %, CI). The RR (95 % CI) of major bleeding was 0.69 (0.57–0.84) p = 0.0002 in favor of apixaban vs warfarin with heterogeneity to be statistically significant I2 63% p = 0.004. Meta-regression analysis with year of publication as moderator shows in bubble plotting that studies published earlier than 2018 were plotted as outliers. The RR (95 % CI) of clinically relevant non-major bleeding (CRNMB) was 0.74 (0.64–0.87) p = 0.0002 favoring again apixaban. Standard apixaban dose over reduced dose is less hemorrhagic compared to warfarin. Overall, in our study the risk of thrombosis in both arms was statistically non-different. In our study we observed less hemorrhagic events with apixaban in ESRD patients compared to warfarin. •Proper anticoagulation therapy in patients with end-stage renal disease is a matter of debate.•The Risk Ratio (95 % CI) of major bleeding was 0.69 (0.57–0.84) p = 0.0002 in favor of apixaban vs warfarin.•The Risk Ratio (95 % CI) of clinically relevant non-major bleeding was 0.74 (0.64–0.87) p = 0.0002 favoring again apixaban compared to warfarin.•Risk Ratio for thrombosis and 95 % CI was 0.81 (0.61–1.12), p = 0.22•Clinical benefit, regarding major hemorrhages, is more evident for the standard dose of apixaban.