Risk of bleeding with factor Xa inhibitors versus unfractionated heparin in patients with acute kidney injury

Link to article at PubMed

Pharmacotherapy. 2023 Feb;43(2):129-135. doi: 10.1002/phar.2759. Epub 2023 Jan 6.


STUDY OBJECTIVE: To compare bleeding and thromboembolic events in patients receiving therapeutic doses of apixaban or rivaroxaban versus unfractionated heparin (UFH) in patients with acute kidney injury (AKI).

DESIGN: Single-center, retrospective, observational study.

SETTING: Ascension St. John Hospital in Detroit, Michigan.

PATIENTS: Hospitalized adult patients who received therapeutic doses of factor Xa inhibitors (n = 250) or UFH (n = 250) for at least 24 h in the setting of AKI.

MEASUREMENTS AND MAIN RESULTS: After adjusting for confounding factors, patients who received a factor Xa inhibitor experienced a lower risk of composite major and clinically relevant nonmajor bleeding (CRNMB) events compared with UFH (OR: 0.57, 95% CI: 0.34-0.94; p = 0.03). There was a significantly decreased risk of CRNMB events in the factor Xa inhibitor group (OR: 0.55, 95% CI: 0.33-0.91, p = 0.02); however, no significant differences in major bleeding or venous thromboembolism (VTE) were noted.

CONCLUSIONS: Our results suggest that it may be preferable to continue patients in AKI on factor Xa inhibitors versus transitioning to UFH due to the lower risk of bleeding events.

PMID:36588500 | DOI:10.1002/phar.2759

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