ISSN 2996-8215
International Journal of Cardiology | Vol. 7, No. 5, May 2016 | pp. 33–40
DOI: 10.46882/2016/IJC/000086
Original Research Article
Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants versus Warfarin in Patients with Atrial Fibrillation and Stage 4 Chronic Kidney Disease
Pierre Larson¹, Jean-Luc Moreau¹, Chantal Dubois²
¹Department of Cardiology, Hôpital de la Timone, Marseille, France
²Division of Nephrology, Clinique Universitaire de Bruxelles, Brussels, Belgium
Abstract:
Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently coexist, significantly increasing both stroke and major bleeding risks. Traditional anticoagulation with warfarin is challenging in patients with advanced kidney disease due to unpredictable international normalized ratios (INRs) and a risk of vascular calcification. This prospective observational study evaluated the safety and clinical efficacy of apixaban compared with warfarin in patients with non-valvular AF and stage 4 CKD. We analyzed clinical data from 210 patients with non-valvular AF and a confirmed baseline estimated glomerular filtration rate (eGFR) between 15 and 29 mL/min/1.73m². Patients were prescribed either adjusted-dose apixaban (2.5 mg twice daily, n = 102) or adjusted warfarin (target INR 2.0–3.0, n = 108). The primary safety endpoint was major bleeding according to ISTH criteria, and the primary efficacy endpoint was a composite of stroke or systemic embolism over a 24-month follow-up. Major bleeding occurred significantly less frequently in the apixaban group than in the warfarin group (4.9% vs. 12.0%, hazard ratio: 0.38, 95% CI: 0.16–0.88, p = 0.02). The incidence of stroke or systemic embolism did not differ significantly between cohorts (apixaban: 2.0% vs. warfarin: 2.8%, hazard ratio: 0.72, 95% CI: 0.20–2.55, p = 0.61). Intracranial hemorrhage was absent in the apixaban cohort. Adjusted-dose apixaban demonstrates a safer clinical profile with significantly lower rates of major bleeding compared to warfarin, while maintaining comparable thromboembolic protection in patients with atrial fibrillation and severe stage 4 chronic kidney disease.
Keywords: Atrial fibrillation, Stage 4 chronic kidney disease, Apixaban, Warfarin, Major bleeding, Stroke prevention
Received: February 15, 2016; Revised: March 24, 2016; Accepted: April 10, 2016; Published: May 20, 2016