Safety and Efficacy of Apixaban Compared to Warfarin for Venous Thromboembolism Treatment in End-Stage Renal Disease: A Meta-Analysis

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Safety and Efficacy of Apixaban Compared to Warfarin for Venous Thromboembolism Treatment in End-Stage Renal Disease: A Meta-Analysis

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Co-author 1

Mohamed Hamouda Elkasaby mohamedhamouda2182000@gmail.com Faculty of Medicine Al-Azhar University Cairo Egypt *

Co-author 2

Omar Elkoumi omarelkoumi@gmail.com Faculty of Medicine Suez University Suez Egypt -

Co-author 3

Ahmed Elkoumi ahmedelkoumi@yahoo.com Directorate of El Sharqeya The Ministry of Health and Population Health Affairs El Sharqeya Egypt -

Co-author 4

Mariam Khaled Elbairy mariam.ksah@med.suezuni.edu.eg Suez University Faculty of Medicine Suez Egypt -

Co-author 5

Ayah Abdulgadir Abdulgadirayah@gmail.com University of Khartoum Faculty of Medicine Khartoum Sudan -

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Introduction

End-stage renal disease (ESRD) is associated with an increased risk of venous thromboembolism (VTE). Anticoagulation in these patients presents unique challenges due to altered drug metabolism and bleeding risks. While warfarin has been the traditional treatment, direct oral anticoagulants (DOACs) such as apixaban offer potential benefits. This meta-analysis evaluates the safety and efficacy of apixaban compared to warfarin for VTE treatment in patients with ESRD.

Methods

A systematic literature search was conducted in PubMed, Scopus, Web of Science, Embase, and Cochrane up to February 2025. Studies comparing clinical outcomes of apixaban and warfarin in adult patients with ESRD (stage 5 chronic kidney disease or on dialysis) were included. Outcomes analyzed were VTE recurrence, all-cause mortality, major bleeding, and clinically relevant non-major bleeding (CRNMB).

Results

Five studies met the inclusion criteria. Apixaban demonstrated no significant difference in VTE recurrence compared to warfarin (RR, 0.65; 95% CI, 0.35–1.20; P = 0.17; I² = 84%). Similarly, all-cause mortality was comparable between apixaban and warfarin (RR, 0.99; 95% CI, 0.91–1.07; P = 0.74; I² = 0%). However, apixaban significantly reduced major bleeding events (RR, 0.68; 95% CI, 0.56–0.82; P < 0.0001; I² = 36%). No significant difference was observed in CRNMB rates (RR, 1.14; 95% CI, 0.48–2.68; P = 0.76; I² = 64%).

Conclusion

Apixaban appears to be a safer alternative to warfarin for the treatment of VTE in ESRD patients, significantly reducing major bleeding without compromising efficacy.

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