ArticleCirculation2023
Associations of Apixaban Dose With Safety and Effectiveness Outcomes in Patients With Atrial Fibrillation and Severe Chronic Kidney Disease.
Article in Circulation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- Anticoagulation approaches in hemodialysis: a systematic review of efficacy, safety, and literature gap.International urology and nephrology · 2026Pooled it
- Safety and Effectiveness Outcomes between Apixaban Versus Vitamin K Antagonists in Atrial Fibrillation Patients on Dialysis.Reviews in cardiovascular medicine · 2024Pooled it
- Standard- Versus Reduced-Dose Apixaban and Vitamin K Antagonists in Patients with Atrial Fibrillation and Advanced Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis.Journal of clinical medicine · 2026Review
- Scoping review of apixaban and rivaroxaban dosing for atrial fibrillation and venous thromboembolism in advanced chronic kidney disease.International journal of clinical pharmacy · 2026Article
- Comparative safety of oral anticoagulants in severe renal impairment.Research and practice in thrombosis and haemostasis · 2026Article
- Recurrent device-related thrombosis after left atrial appendage closure with the watchman FLX: A case report and literature review.International journal of cardiology. Cardiovascular risk and prevention · 2026Review
- Pharmacogenomics of direct oral anticoagulants: a systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2026Review
- What to do with key cardiovascular drugs when kidney function worsens?Clinical kidney journal · 2026Review
- Are the Direct Oral Anticoagulants Better Than Warfarin for the Prevention and Treatment of Stroke and Atrial Fibrillation?Handbook of experimental pharmacology · 2026Review
- Managing patients with a history of arterial disease and new venous thromboembolism.Hematology. American Society of Hematology. Education Program · 2025Article
- Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review.Journal of cardiovascular development and disease · 2025Review
- Safety and effectiveness of apixaban use for stroke prevention during Ramadan fasting (the API-RAM study).Frontiers in pharmacology · 2025Article
- Ten tips to manage oral anticoagulation in hemodialysis patients with atrial fibrillation.Clinical kidney journal · 2024Review
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- Article
- Exploring Apixaban Pharmacokinetics, Pharmacodynamics, and Safety in Hemodiafiltration Patients.Kidney international reports · 2024Article
- Treatment strategies of the thromboembolic risk in kidney failure patients with atrial fibrillation.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Review
- Assessment and Management of Atrial Fibrillation in Older Adults with Frailty.Geriatrics (Basel, Switzerland) · 2024Review
- Anticoagulation in Patients with Chronic Kidney Disease.American journal of nephrology · 2024Review
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundRecommendations for apixaban dosing on the basis of kidney function are inconsistent between the US Food and Drug Administration and European Medicines Agency for patients with atrial fibrillation. Optimal apixaban dosing in chronic kidney disease remains unknown.
methodsWith the use of deidentified electronic health record data from the Optum Labs Data Warehouse, patients with atrial fibrillation and chronic kidney disease stage 4/5 initiating apixaban between 2013 and 2021 were identified. Risks of bleeding and stroke/systemic embolism were compared by apixaban dose (5 versus 2.5 mg), adjusted for baseline characteristics by the inverse probability of treatment weighting. The Fine-Gray subdistribution hazard model was used to account for the competing risk of death. Cox regression was used to examine risk of death by apixaban dose.
resultsAmong 4313 apixaban new users, 1705 (40%) received 5 mg and 2608 (60%) received 2.5 mg. Patients treated with 5 mg apixaban were younger (mean age, 72 versus 80 years), with greater weight (95 versus 80 kg) and higher serum creatinine (2.7 versus 2.5 mg/dL). Mean estimated glomerular filtration rate was not different between the groups (24 versus 24 mL·min
conclusionsCompared with 2.5 mg, use of 5 mg apixaban was associated with a higher risk of bleeding in patients with atrial fibrillation and severe chronic kidney disease, with no difference in the risk of stroke/systemic embolism or death, supporting the apixaban dosing recommendations on the basis of kidney function by the European Medicines Agency, which differ from those issued by the US Food and Drug Administration.
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Registered trials
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