Meta-analysis on risk of bleeding with apixaban in patients with renal impairment
Abstract
Apixaban is a novel oral anticoagulant which is approved for the management of atrial fibrillation and venous thromboembolism prophylaxis. There have been concerns regarding bleeding risks with apixaban in patients with renal impairment. We performed a systematic review and meta-analysis to evaluate the risk of bleeding with apixaban in these patients. Relevant studies were identified through electronic literature searches of MEDLINE, EMBASE, Cochrane library, and clinicaltrials.gov (from inception to February 24, 2014). Phase III randomized controlled trials that compared apixaban with conventional agents (vitamin K antagonist and/or warfarin, low molecular weight heparin, aspirin, and placebo) were included. We defined mild renal impairment as creatinine clearance of 50 to 80 ml/min and moderate to severe renal impairment as creatinine clearance <50 ml/min. Study-specific risk ratios were calculated, and between-study heterogeneity was assessed using the I(2) statistics. In 6 trials involving 40,145 patients, the risk of bleeding with apixaban in patients with mild renal impairment was significantly less (risk ratio 0.80, 95% confidence interval 0.66 to 0.96, I(2) = 13%) compared with conventional anticoagulants. In patients with moderate to severe renal impairment, the risk of bleeding with was found to be similar (risk ratio 1.01, 95% confidence interval 0.49 to 2.10, I(2) = 72%). In conclusion, compared with the conventional agents, bleeding risk with apixaban in patients with mild and moderate to severe renal insufficiency is lower and similar, respectively.
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A previous meta-analysis showed that in various settings, including CKD patients, apixaban was safer than other agents like rivaroxaban and dabigatran.
“A previous meta-analysis had shown that in various settings, including in CKD patients, apixaban was safer than other agents like rivaroxaban and dabigatran. 18”
From Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world (2019) · cites this paper as [18]
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- Authors
- Pathak, R., Pandit, A., Karmacharya, P., Aryal, M. R., Ghimire, S., Poudel, D. R., & Shamoun, F. E.
- Affiliations
- Reading Hospital (US)
- Mayo Clinic in Arizona (US)
- Corresponding author
- Pandit, Anil
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 115
- Issue
- 3
- Pages
- 323-327
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2126783794
- Cited by
- 41
- References
- 18
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2022: 1 · 2020: 2 · 2019: 2 · 2018: 10 · 2017: 4 · 2016: 13 · 2015: 6
- FWCI
- 5.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- apixaban, renal dysfunction, bleeding risk, oral anticoagulants, atrial fibrillation, thromboprophylaxis, creatinine clearance, warfarin, vitamin K antagonists, low molecular weight heparin, aspirin
- MeSH terms
- Atrial Fibrillation, Hemorrhage, Humans, Pyrazoles, Pyridones, Risk, Severity of Illness Index, Stroke, Renal Insufficiency, Venous Thromboembolism, Factor Xa Inhibitors
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