만성신장병환자에서 apixaban과 warfarin의 안전성 비교: 체계적 문헌고찰 및 메타분석

• Published in: 한국임상약학회지 Vol. 31; no. 2; pp. 87 - 95
• Main Authors: 남재현, 김채영, 이유경, 정다움, 곽혜영, 정지은, Nam, Jae Hyun, Kim, Chae Young, Lee, Yoo Kyung, Jung, Da Woom, Gwak, Hye Young, Chung, Jee Eun
• Format: Journal Article
• Language: Korean
• Published: 30.06.2021
• Subjects: Chronic kidney disease; bleeding; thromboembolism; apixaban; warfarin
• ISSN: 1226-6051

Background: Patients with chronic kidney disease (CKD) are at a high risk of stroke-related morbidity, mortality, and bleeding. However, the overall risk/benefit of anticoagulant therapy among patients with CKD remains unclear. Methods: The MEDLINE, EMBASE, and CENTRAL databases were comprehensively searched until July 31, 2020, to investigate the safety and efficacy of apixaban in patients with stage 4 or 5 CKD, as compared with warfarin. The primary outcome was an incidence of major bleeding. Secondary outcomes included composite bleeding (major, clinically relevant, and minor bleeding), venous thromboembolism (VTE), stroke, and death. Results: In total, seven studies consisting of 10,816 patients were included. Compared with warfarin, apixaban was associated with a reduced risk of major bleeding (OR 0.49, 95% CI 0.41-0.58). In terms of composite bleeding, apixaban tended to pose a significantly lower risk than warfarin (OR 0.51, 95% CI 0.37-0.71). There was no difference between apixaban and warfarin with respect to the risk of stroke or death (stroke: OR 1.23, 95% CI 0.49-3.12; death: OR 0.73, 95% CI 0.45-1.18). Conclusion: Among patients with stage 4 or 5 CKD, the use of apixaban was associated with a lower risk of bleeding compared to warfarin and was also found to pose no excess risk of thromboembolic events.