Am J Kidney Dis

Study compares oral anticoagulants in patients with advanced CKD

December 21, 2023

Rivaroxaban and warfarin were associated with a higher rate of major bleeding compared with apixaban among patients with afib and advanced CKD, suggesting a superior safety profile for apixaban in this high-risk population.

• This cohort study referenced two nationwide U.S. claims databases and included initiators of warfarin vs. apixaban (N = 12,488) and rivaroxaban vs. apixaban (N = 5,720) with nonvalvular afib and CKD stage 4-5.
• Compared with apixaban, warfarin initiation was associated with a higher rate of major bleeding (hazard ratio [HR] 1.85; 95% confidence interval [CI], 1.59-2.15), including major GI bleeding (HR, 1.86; CI 1.53-2.25) and intracranial bleeding (HR, 2.15; CI, 1.42-3.25). Rivaroxaban vs. apixaban was also associated with a higher rate of major bleeding (HR, 1.69; CI, 1.33-2.15).
• All-cause mortality was similar for warfarin (HR, 1.08; CI, 0.98-1.18) or rivaroxaban (HR, 0.94; CI, 0.81-1.10) vs. apixaban. Furthermore, no statistically significant differences for ischemic stroke were observed for warfarin or rivaroxaban vs. apixaban, although confidence intervals were wide.

Source:

Fu, E. et al. (2023, October 13). Am J Kidney Dis. Comparative Safety and Effectiveness of Warfarin or Rivaroxaban Versus Apixaban in Patients With Advanced CKD and Atrial Fibrillation: Nationwide U.S. Cohort Study. https://pubmed.ncbi.nlm.nih.gov/37839687/