Safety and efficacy of apixaban versus warfarin in patients with end‐stage renal disease: Meta‐analysis

Abstract

Among patients with advanced CKD and ESRD, the use of apixaban was associated with lower risk of major bleeding compared to warfarin, and was found to be relatively effective with no excess risk of thromboembolic events.

Comparative safety and efficacy of apixaban versus warfarin in patients with end stage renal disease: Meta‐analysis

“…We thank the reader for important comments to our article. 1 First of all, we acknowledge this limitation of our study that every reader should bear in mind before employing our manuscript in the part of providing care for patients with advanced chronic kidney disease (CKD)/end-stage renal disease (ESRD) requiring renal replacement therapy. As we know, the data regarding the use anticoagulation other than vitamin K antagonists in the CKD/ESRD patients lack the well-designed study; however, we are aware of two ongoing randomized controlled trials (AXADIA NCT:02933697 and RENAL-AF NCT:02942407) which are expected to be completed in 2019.…”

“…We thank the reader for important comments to our article . First of all, we acknowledge this limitation of our study that every reader should bear in mind before employing our manuscript in the part of providing care for patients with advanced chronic kidney disease (CKD)/end‐stage renal disease (ESRD) requiring renal replacement therapy.…”

“…The reader raised an important point that of 49,953 patients with stage 4–5 CKD in the study by Noseworthy et al., two‐thirds of the patients were not treated with oral anticoagulants. In fact, only 1,034 patients were on apixaban, resulting in a total of 1,291 advanced CKD/ESRD patients who received apixaban and 95% of those used apixaban for atrial fibrillation in our systematic reviews . Regarding the result of analysis from Figure 2 in the manuscript, the incidence of major bleeding was calculated without incorporation of the data from the study by Noseworthy et al .…”

Safety and efficacy of apixaban versus warfarin in patients with end‐stage renal disease: Meta‐analysis

“…We thank the reader for very important comments to our article . We acknowledge and apologize for the error statement in our manuscript: “ At the present, apixaban is the only non‐vitamin K oral anticoagulant (NOAC) approved by the food and drug administration (FDA) for use with patients with creatinine clearance < 15 mL/min or end‐stage renal disease (ESRD) .” Referring to the latest consensus by KDIGO published in the European Heart Journal in 2018, they put the recommendation about the use of both apixaban and rivaroxaban in atrial fibrillation patients with ESRD on dialysis .…”

Re: Chokesuwattanaskul et al. Safety and efficacy of apixaban versus warfarin in patients with end‐stage renal disease: Meta‐analysis

“…Thus, my two concerns are the inclusion of a single very large and statistically dominant abstract‐based data report in a meta‐analysis and the inaccurate representation of the data in that abstract in the paper itself. These issues are likely to substantively affect the interpretation of this study.…”