Safety and Efficacy of Apixaban Compared with Warfarin for Venous Thromboembolism in ESRD: A Meta-Analysis

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Background: End-stage renal disease (ESRD) is associated with an increased risk of venous thromboembolism (VTE). Anticoagulation in these patients presents unique challenges due to altered drug metabolism and bleeding risks. While warfarin has been the traditional treatment, direct oral anticoagulants (DOACs) such as apixaban offer potential benefits. This meta-analysis evaluates the safety and efficacy of apixaban compared to warfarin for VTE treatment in patients with ESRD. Methods: A systematic literature search was conducted in PubMed, Scopus, Web of Science, Embase, and Cochrane up to February 2025. Studies comparing clinical outcomes of apixaban and warfarin in adult patients with ESRD (stage 5 chronic kidney disease or on dialysis) were included. Outcomes analyzed were VTE recurrence, all-cause mortality, major bleeding, and clinically relevant non-major bleeding (CRNMB). Risk ratio (RR) and 95% confidence interval (CI) were used to pool results. The I2 statistic utilized to categorize heterogeneity. Results: Six studies met the inclusion criteria. Apixaban demonstrated no significant difference in VTE recurrence compared to warfarin (RR, 0.65; 95% CI, 0.35–1.20; P = 0.17; I2 = 84%). Similarly, all-cause mortality was comparable between apixaban and warfarin (RR, 0.99; 95% CI, 0.91–1.07; P = 0.74; I 2 = 0%). However, apixaban significantly reduced major bleeding events (RR, 0.68; 95% CI, 0.56–0.82; P < 0.0001; I2 = 36%). No significant difference was observed in CRNMB rates (RR, 1.14; 95% CI, 0.48–2.68; P = 0.76; I2 = 64%). Conclusion: Apixaban appears to be a safer alternative to warfarin for the treatment of VTE in ESRD patients, significantly reducing major bleeding without compromising efficacy.Forest plot of major bleeding.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.