Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants) D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-008 - Safety And Feasibility Of Apixaban Versus Warfarin In Patients With End-stage Renal Disease On Hemodialysis: A Meta-analysis (ID 37)


Background: Warfarin is traditionally the drug of choice for stroke prophylaxis or treatment of venous thromboembolism in patients with end-stage renal disease (ESRD) on hemodialysis as data on the use of apixaban in these patients is scarce.
Objective: We aimed to assess safety and feasibility of apixaban in patients with ESRD on hemodialysis as compared to warfarin.
Methods: A comprehensive literature search in PubMed, Google Scholar and Cochrane databases from inception till November 25th, 2019 was performed. Studies reporting clinical outcomes comparing Apixaban (2.5mg bid or 5mg bid) versus Warfarin in ESRD patients on hemodialysis were included. A meta-analysis was performed using random-effects model to calculate the risk ratio (RR) and 95% confidence interval (CI).
Results: 4 studies including 9,862 patients (apixaban = 2,547, warfarin = 7,315) met inclusion criteria. 1379 patients were on 2.5mg bid Apixaban and 1168 were on 5mg bid. Mean pooled CHADSVASc score was 4.6 ± 0.67. Apixaban was associated with lower rates of major bleeding [RR 0.53, 95% CI 0.45-0.64], p<0.0001], gastrointestinal (GI) bleed [RR 0.65, 95% CI 0.55-0.76, p<0.0001], intracranial bleed [RR 0.56, 95% CI 0.36-0.89, p=0.01], and stroke/systemic embolism [RR 0.65, 95% CI 0.52-0.83, p=0.0004] compared with warfarin in patients with ESRD on hemodialysis.
Conclusion: Our meta-analysis indicates that among patients with end-stage renal disease on hemodialysis, apixaban is associated with reduced risk of major bleeding, GI bleeding, stroke/systemic embolism, and intracranial bleed as compared to warfarin.