Meta-analysis evaluating apixaban in patients with atrial fibrillation and end-stage renal disease requiring dialysis.

Background

Warfarin is considered the primary oral anticoagulant for patients with atrial fibrillation and end-stage renal disease (ESRD) requiring dialysis. Although warfarin can offer significant stroke prevention in this population, the accompanying major bleeding risks make warfarin nearly prohibitive. Apixaban was shown to be superior to warfarin in preventing stroke or systemic embolism, with a lower risk of bleeding and mortality in a large, randomized trial of individuals with mostly normal renal function but none with ESRD.

Methods

We systematically reviewed evidence comparing apixaban versus warfarin for atrial fibrillation in this population, and evaluated outcomes of stroke or systemic embolism, and major bleeding using random-effects models. The main safety outcome was major bleeding, and the main effectiveness outcome was stroke or systemic embolism.

Results

We found five observational studies of 10 036 patients (2638 receiving apixaban, and 7398 receiving warfarin) meeting inclusion criteria. Pooled analysis demonstrated a significant reduction in major bleeding with apixaban as compared to warfarin (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.42-0.61;

Conclusion

Apixaban was associated with superior outcomes and reduced adverse events compared to warfarin in observational studies of patients with atrial fibrillation on dialysis. Randomized controlled studies are needed to confirm these findings.

Informations de copyright

© 2024 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.

Déclaration de conflit d'intérêts

Dr. Mavrakanas reports personal fees from Daiichi Sankyo and Pfizer, outside the submitted work and received salary support from the Department of Medicine, McGill University, Montreal, Canada. Dr. Essebag has received honoraria from Bayer, Boehringer Ingelheim, BMS Pfizer, and Servier and is the recipient of a Clinical Research Scholar Award from the Fonds de recherche du Québec‐Santé (FRQS). Dr Huynh has received significant research grants from Boehringer Ingelheim Canada, Bristol Myers Squibb Canada, Pfizer Canada, and Bayer Canada. The other authors have no relevant disclosures. There was no funding provided for this study.