만성신장병환자에서 apixaban과 warfarin의 안전성 비교: 체계적 문헌고찰 및 메타분석open accessApixaban versus Warfarin in Patients with Chronic Kidney Disease; A Systematic Review and Meta-analysis
- Other Titles
- Apixaban versus Warfarin in Patients with Chronic Kidney Disease; A Systematic Review and Meta-analysis
- Authors
- 남재현; 김채영; 이유경; 정다움; 곽혜영; 정지은
- Issue Date
- Jun-2021
- Publisher
- 한국임상약학회
- Keywords
- Chronic kidney disease; apixaban; warfarin; bleeding; thromboembolism
- Citation
- 한국임상약학회지, v.31, no.2, pp.87 - 95
- Indexed
- KCI
- Journal Title
- 한국임상약학회지
- Volume
- 31
- Number
- 2
- Start Page
- 87
- End Page
- 95
- URI
- https://scholarworks.bwise.kr/erica/handle/2021.sw.erica/108291
- DOI
- 10.24304/kjcp.2021.31.2.87
- ISSN
- 1226-6051
- Abstract
- 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.
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