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September 6, 2026British Journal of Clinical PharmacologyOpen Access

Apixaban 2.5 mg BID shows similar bleeding and thrombotic events to VKAs in renal replacement therapy.

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Why the study?

Does apixaban 2.5 mg twice daily compared to VKAs reduce bleeding and thrombotic events in patients with ESRD receiving RRT?

Population

88 patients with end-stage renal disease receiving renal replacement therapy

Comparison

Apixaban 2.5 mg twice daily vs Vitamin K antagonists (VKAs)

Design

Cohort

Key result

Apixaban 2.5 mg twice daily was associated with similar rates of major bleeding (0% vs 7.3%; p=0.102) and thrombotic events compared to vitamin K antagonists in patients on renal replacement therapy.

Authors

JBJ. Bartoli-AbdouACAlexander T. CohenLVLucy Vernon

Discussion

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Overview

Low-dose apixaban was associated with similar bleeding and thrombotic rates versus VKAs in RRT; leaves open its role as alternative pending randomized trials.

Key Points

  • To compare safety and thrombotic outcomes between low-dose apixaban (2.5 mg twice daily) and vitamin K antagonists in patients with end-stage renal disease undergoing renal replacement therapy.
  • Retrospective service evaluation of electronic records at a tertiary anticoagulation clinic.
  • Analyzed 88 patients with end-stage renal disease on renal replacement therapy (55 receiving VKAs and 33 receiving apixaban 2.5 mg twice daily).
  • Assessed bleeding events, thrombotic events, and trough anti-Xa drug levels among apixaban users.
  • Major bleeding occurred in 0% (0/33) of the apixaban group versus 7.3% (4/55) of the VKA group (χ² = 2.667, p = 0.102), with no difference in time to major or clinically relevant non-major bleeding (χ² = 1.252, p = 0.263).
  • Thrombotic events (all stroke) occurred at 7.1 events/100 patient-years (3 events) with apixaban versus 1.1 events/100 patient-years (1 event) with VKAs (χ² = 3.291, p = 0.070).
  • Trough anti-Xa levels remained below the upper limit of normal for the general population reference range in 84 of 85 analyzed samples.

Study Design

Type

Observational (n=88)

Multicenter

No

Structured PICO

Does apixaban 2.5 mg twice daily compared to VKAs reduce bleeding and thrombotic events in patients with ESRD receiving RRT?

P
Population
88 patients with end-stage renal disease receiving renal replacement therapy treated with either apixaban 2.5 mg twice daily or vitamin K antagonists.
E
Exposure
Apixaban 2.5 mg twice daily
C
Comparator
Vitamin K antagonists (VKAs)
O
Outcome
Bleeding (major bleeds, clinically relevant non-major bleeding) and thrombotic outcomes (stroke)safety

Main Result

Absolute Event Rate: 0% vs 7.3%

p-value: p=0.102

Low-dose apixaban (2.5 mg twice daily) appears to have similar bleeding and thrombotic outcomes compared to VKAs in patients with ESRD on RRT, suggesting it may be a viable second-line option.

Cite This Study

Bartoli-Abdou et al. (2026) conducted an observational in End-stage renal disease (ESRD) receiving renal replacement therapy (RRT) (n=88). Apixaban vs. Vitamin K antagonists (VKAs) was evaluated on Major bleeds (p=0.102). Apixaban 2.5 mg twice daily was associated with similar rates of major bleeding (0% vs 7.3%; p=0.102) and thrombotic events compared to vitamin K antagonists in patients on renal replacement therapy.

synapsesocial.com/papers/6a9d1e3328139818eab20eechttps://doi.org/10.1002/bcp.70805
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