Apixaban may provide better long-term kidney outcomes vs warfarin
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For patients with non-valvular atrial fibrillation, study results showed treatment with apixaban was associated with a lower risk for chronic kidney disease progression compared with warfarin.
However, researchers noted it “remains uncertain” whether the drug was also more effective for preventing incident kidney failure.
According to James B. Wetmore, MD, MS, of the chronic disease research group at Hennepin Healthcare Research Institute, and colleagues, “warfarin may be injurious to kidney health,” and this concern is growing, making direct oral anticoagulants [DAOCs] “attractive alternatives” for ischemic stroke prevention in patients with atrial fibrillation.
“DOACs are appealing given the narrow therapeutic window, need for frequent laboratory monitoring, and complex drug interaction profile that characterizes warfarin use,” the researchers wrote. “In contrast to warfarin, DOACs act relatively quickly, have comparatively few drug interactions, and generally do not require ongoing laboratory monitoring. However, DOACs are more expensive than warfarin, and their safety profiles are unclear in patients with CKD.”
To investigate, Wetmore and colleagues conducted a retrospective cohort study of 12,816 Medicare recipients with stages 3, 4, or 5 CKD and incident AF who received a new prescription for apixaban or warfarin between 2013 and 2017 (84% with stage 3 CKD; mean age, 80 years; 51% were women; 88% were white).
Researchers considered whether patients progressed to a more advanced stage of CKD or to kidney failure.
Results showed patients on either medication experienced incident kidney failure at a rate of 2.1 events per 100 patients per year, with a hazard ratio for incident kidney failure of 0.98 for apixaban compared with warfarin.
For CKD progression, researchers observed a rate of 11.4 events per 100 patients per year for patients taking apixaban compared with 12 for those taking warfarin and an HR of 0.90.
“Combined with the results of other studies, our results suggest that apixaban may be associated with superior long-term renal outcomes relative to warfarin in this population, but this cannot be definitively determined in the absence of data from clinical trials,” Wetmore and colleagues concluded of the findings.
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