Meta-analysis comparing apixaban versus warfarin anticoagulation therapies for patients with severe renal insufficiency

Objective To compare effectiveness and safety of apixaban versus warfarin anticoagulation therapies patients with severe renal insufficiency, by means of meta-analysis. Methods All literatures in both Chinese and English about apixaban and warfarin anticoagulation therapies for patients with severe renal insufficiency, published by December 2018, were searched in various databases. The included studies were evaluated for quality, and the software of Comprehensive Meta Analysis was adopted to conduct the meta-analysis. Results Through screening, five studies were included into the analysis consisting of 76 386 patients. Meta-analysis showed:Compared to warfarin, apixaban was significantly associated with reduced risk of major bleeding in patients with stage 4-5 and hemodialysis, with statistically significant difference (OR=0.49, 95%CI:0.42-0.58, P<0.01). The risk of occurrence of bleeding of other severity had no significant difference between the apixaban and warfarin groups(risk for moderate bleeding:OR=1.74,95%CI 0.77-3.95,P=0.18;risk for mild bleeding:OR=0.72,95%CI 0.14-3.79,P=0.69). The risks for stroke and systematic embolism were significantly lower than those for warfarin (OR=0.65,95%CI 0.51-0.82,P<0.01). Conclusions In those patients with severe renal insufficiency, compared to warfarin, apixaban has lower risk for major bleeding and ischemia stroke or thrombosisembolism. Compared to warfarin, it is found that apixaban has higher safety and efficacy in patients with severe renal insufficiency.