title: 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.
authors.affiliation: Department of Medicine, Reading Health System, Reading, Pennsylvania.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Pathak
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Arizona. Electronic address: anil.pandit@hotmail.com.
authors.forename: Anil
authors.initials: A
authors.lastname: Pandit
authors.affiliation: Department of Medicine, Reading Health System, Reading, Pennsylvania.
authors.forename: Paras
authors.initials: P
authors.lastname: Karmacharya
authors.affiliation: Department of Medicine, Reading Health System, Reading, Pennsylvania.
authors.forename: Madan Raj
authors.initials: MR
authors.lastname: Aryal
authors.affiliation: Department of Medicine, Reading Health System, Reading, Pennsylvania.
authors.forename: Sushil
authors.initials: S
authors.lastname: Ghimire
authors.affiliation: Department of Medicine, Reading Health System, Reading, Pennsylvania.
authors.forename: Dilli Ram
authors.initials: DR
authors.lastname: Poudel
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Arizona.
authors.forename: Fadi E
authors.initials: FE
authors.lastname: Shamoun
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000150:complications; D006801:Humans; D011720:Pyrazoles / Q000009:adverse effects*; D011728:Pyridones / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000150:complications*; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban