The Risk of Major Bleeding With Apixaban Administration in Patients With Acute Kidney Injury

Author:

Givens Gabrielle1,Neu Daniel1,Marler Jacob12ORCID

Affiliation:

1. Department of Pharmacy, Veterans Affairs Hospital, Memphis, TN, USA

2. Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis, TN, USA

Abstract

Background: Apixaban is eliminated by the kidneys and in acute kidney injury (AKI) there is potential for an increase in apixaban exposure and bleeding events. In one instance, data have shown higher than normal bleed risk in patients with AKI, unless calibrated anti-factor Xa monitoring is used, which is not widely available. Objective: To evaluate bleeding with apixaban administration to hospitalized patients with an AKI in an unmonitored real-world scenario. Methods: We conducted a retrospective study of patients admitted to a large urban academic teaching hospital from April 2015 to March 2022, who received apixaban for venous thromboembolism or nonvalvular atrial fibrillation (NVAF). The primary outcome evaluated major bleeding when apixaban was administered to patients with or without an AKI. Results: A total of 232 patients were evaluated (116 per group). Most patients (79.7%) were on apixaban for NVAF, 32.7% had chronic kidney disease, 58.2% were on a medication increasing bleed risk, and HAS-BLED score was a median of 2 in both groups. No differences were noted between groups for bleeding (AKI group 7.8% vs non-AKI 3.4%; P = 0.15), and on regression analysis, coadministration of a P2Y12 inhibitor was predictive of major bleeding (odds ratio = 5.9; 95% confidence interval = 1.4-23.6). Conclusion and Relevance: Although no differences between groups were noted, apixaban use in the AKI group resulted in a higher than normally reported incidence of apixaban-associated major bleeding, and concomitant antiplatelet use increased bleed risk as well. Cautious use of apixaban and further investigation with larger studies are warranted in this area.

Publisher

SAGE Publications

Subject

Pharmacology (medical)

Reference24 articles.

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Things We Do for No ReasonTM: Dose adjusting apixaban in acute kidney injury;Journal of Hospital Medicine;2024-01-31

2. Risk of bleeding with factor Xa inhibitors versus unfractionated heparin in patients with acute kidney injury;Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy;2023-01-06

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