Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2025 Mar;58(3):380-390.
doi: 10.1007/s11239-025-03075-5. Epub 2025 Feb 22.

Apixaban versus warfarin for treatment of venous thromboembolism in patients with severe renal impairment: a multicenter study

Paige Hanke  1 , Ma Emmanuelle Domingo  2 , Ghenella Salanio  3 , Kulsoom Ahmed  4 , Jingyu Hu  5 , Kristin Hendricks  6 , Jacob Howard  7 , Tori Hashimura  8 , Chris Guiliano  1   9 , Bradley J Haan  5 , Tsz Hin Ng  1 , Denise Kelley  2   10 , Tamara Knight  2 , Kathleen Koopman  4 , Monika Obstoj  4 , Thomas Breeden  5 , Dumitru Sirbu  6 , Meredith Romano  8 , Andrew Harpenau  7 , Rebecca Konneker  7 , Jason Acevedo  3 , Neil Pan  2 , Stephanie B Edwin  11
Affiliations
Comparative Study

Apixaban versus warfarin for treatment of venous thromboembolism in patients with severe renal impairment: a multicenter study

Paige Hanke et al. J Thromb Thrombolysis. 2025 Mar.

Erratum in

Abstract

Limited evidence exists regarding the use of factor Xa inhibitors for the treatment of venous thromboembolism (VTE) in patients with severe renal impairment. Notably, these patients were excluded from clinical trials.The goal of this study was to examine the safety and effectiveness of apixaban versus warfarin for the treatment of acute VTE in patients with severe renal impairment.This retrospective cohort study was conducted across 36 Ascension Health sites between 2014 and 2024. Adult patients receiving apixaban or warfarin for VTE treatment with severe renal impairment were included. The primary outcome was time to composite bleeding event within six months.This study included 1200 patients receiving apixaban and 600 patients receiving warfarin. Overall, 23.4% of the study population had ESRD requiring renal replacement therapy. Among patients not requiring renal replacement therapy, stage IV CKD was most common (43.8%). No difference in time to composite bleeding events (HR 1.01; 95% CI 0.74-1.38, p = 0.97) or recurrent VTE (HR 1.24; 95% CI 0.70-2.18, p = 0.46) were noted after controlling for confounders. Furthermore, major bleeding (4.7% vs. 7.5%, p = 0.43) and clinically-relevant non-major bleeding (4.3% vs. 6.2%, p = 0.08) were similar between groups. Apixaban was associated with a significantly reduced incidence of anticoagulation-related ED admission (6.8% vs. 9.8%, p = 0.02) compared to warfarin. Anticoagulation-related readmission (7.4% vs. 8%, p = 0.66) and time to all-cause mortality (5.2% vs. 6.2%, p = 0.38) were similar between groups.No differences in safety or effectiveness were noted between apixaban and warfarin, providing encouraging evidence to support the use of apixaban for treatment of acute VTE in patients with severe renal impairment.

Keywords: Anticoagulation; Apixaban; Bleeding; Chronic kidney disease; Direct-acting oral anticoagulants; Factor Xa inhibitors; Venous thromboembolism.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflicts of interest: The authors declare no conflicts of interest.

References

    1. Olesen JB, Lip GY, Kamper AL et al (2012) Stroke and bleeding in atrial fibrillation with chronic kidney disease. N Engl J Med 367(7):625–635. https://doi.org/10.1056/NEJMoa1105594 - DOI - PubMed
    1. Middeldorp S, Nieuwlaat R, Baumann Kreuziger L et al (2023) American society of hematology 2023 guidelines for management of venous thromboembolism: thrombophilia testing. Blood Adv 7(22):7101–7138. https://doi.org/10.1182/bloodadvances.2023010177 - DOI - PubMed - PMC
    1. Stevens SM, Woller SC, Kreuziger LB et al (2022) Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report [published correction appears in Chest.;162(1):269. https://doi.org/10.1016/j.chest2022.05.028 ]. Chest. 2021;160(6):e545-e608. doi:https://doi.org/0.1016/j.chest.2021.07.055
    1. Fu CM, Li LC, Lee YT, Wang SW, Hsu CN (2021) Apixaban vs. Warfarin in atrial fibrillation patients with chronic kidney disease. Front Cardiovasc Med 8:752468 Published 2021 Oct 18. https://doi.org/10.3389/fcvm.2021.752468 - DOI - PubMed - PMC
    1. Agnelli G, Buller HR, Cohen A et al (2013) Oral Apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369(9):799–808. https://doi.org/10.1056/NEJMoa1302507 - DOI - PubMed

MeSH terms

LinkOut - more resources