# Safety Profile of Warfarin and Apixaban for Deep Vein Thrombosis in Patients With Chronic Kidney Disease

## TL;DR

This study compares the safety of warfarin and apixaban for treating deep vein thrombosis in patients with chronic kidney disease, finding fewer fatal bleeds with apixaban.

## Contribution

The study provides new comparative safety data for anticoagulants in CKD patients with DVT, suggesting apixaban may be safer despite non-significant results.

## Key findings

- Apixaban group had fewer fatal bleeding episodes (4.4%) compared to warfarin (9.6%).
- Major bleeding was less frequent with apixaban (14.0%) than warfarin (16.7%).
- No statistically significant differences in bleeding outcomes between the two groups.

## Abstract

Background

Patients with chronic kidney disease (CKD) are more susceptible to bleeding complications and thromboembolic events. Current recommendations provide limited guidance on the optimal anticoagulant for CKD patients with deep vein thrombosis (DVT). Therefore, this study was planned. By estimating the proportion of bleeding episodes associated with apixaban and warfarin in CKD patients, this study aimed to address this knowledge gap and assist physicians in selecting safer and more effective treatment options.

Objective

The objective of this study is to compare the safety profiles of warfarin and apixaban for DVT in patients with CKD.

Methods

This descriptive comparative study was conducted at the Department of General Internal Medicine, Mayo Hospital, Lahore, Pakistan, from September 17, 2022, to September 16, 2024. Male and female patients aged 30 to 70 years with CKD, diagnosed with DVT, and started on warfarin or apixaban were enrolled. A total of 228 patients were included, with 114 in the apixaban group and 114 in the warfarin group. Patients were compared for the safety profiles of both drugs, assessed in terms of bleeding tendencies and worsening renal function. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2018; IBM Corp., Armonk, NY, USA).

Results

The overall mean age of participants was 52 years. The mean age in the apixaban group was 54.73 ± 12.17 years, and in the warfarin group, it was 49.99 ± 12.14 years. Mean CKD duration in the apixaban and warfarin groups was 8.55 ± 2.14 years and 9.46 ± 2.73 years, respectively. Overall, 159 participants (69.7%) were male, with 80 (70.2%) in the apixaban group and 79 (69.3%) in the warfarin group. Participants over 50 years of age totaled 116 (50.9%), with 69 (60.5%) in the apixaban group and 47 (41.2%) in the warfarin group. Overall, 16 patients (7.0%) experienced a fatal bleed, including five (4.4%) in the apixaban group and 11 (9.6%) in the warfarin group. Major bleeding occurred in 16 patients (14.0%) receiving apixaban and 19 (16.7%) receiving warfarin. The chi-square p-values for differences in fatal bleed, major bleed, and minor or no bleed between apixaban and warfarin were 0.120, 0.582, and 0.153, respectively.

Conclusions

This study provided valuable information regarding the safety profile of warfarin and apixaban for DVT in individuals with CKD. The apixaban group experienced fewer fatal bleeding episodes than the warfarin group. Similarly, serious bleeding episodes were less frequent with apixaban compared with warfarin. However, there was no statistically significant difference between the two treatment groups. The study findings imply that apixaban might be a safer option than warfarin for anticoagulation in patients with CKD, but, due to the lack of statistical significance and the restriction of the study to a single center, further carefully designed prospective multicenter studies are warranted to validate these results.