{"doi":"10.4140/tcp.n.2023.86","title":"A Review of the Safety and Efficacy of Apixaban in Patients With Severe Renal Impairment","abstract":"<jats:p><jats:bold>Background</jats:bold> Apixaban is a direct-acting oral anticoagulant (DOAC) used to treat or prevent thromboembolic events. Renal impairment limits DOAC use. Studies supporting Food and Drug Administration (FDA)-approval for apixaban did not include patients with a creatinine clearance\n &lt; 25 mL/min. Consequently, limited guidance for use in end-stage renal disease (ESRD) exists in the package insert. An in-depth literature search reveals substantial evidence supporting the safety and effectiveness of apixaban in ESRD. Clinicians must have access to this evidence so that\n patients in need of apixaban therapy are appropriately managed.  <jats:bold>Objective</jats:bold> To provide an up-to-date review of literature surrounding the safety and effectiveness of apixaban in patients with ESRD.  <jats:bold>Data Sources</jats:bold> A PubMed search of research studies published\n through November 2021 was performed using a combination of the following terms: apixaban, severe renal impairment, end-stage renal disease, DOACs, safety, effectiveness, atrial fibrillation, anticoagulation.  <jats:bold>Study Selection/Data Extraction</jats:bold> Relevant original research, review\n articles, and guidance recommendations were assessed for the use of apixaban in patients with ESRD. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results.  <jats:bold>Data Synthesis</jats:bold>\n Numerous studies exist supporting the safety and effectiveness of apixaban in patients with ESRD who may or may not be on dialysis.  <jats:bold>Conclusion</jats:bold> Multiple studies suggest that apixaban is possibly associated with a lower prevalence of bleeding and thromboembolic events\n compared with warfarin therapy in patients with ESRD and can be safely initiated in those within this sub-group who require anticoagulation with a DOAC. Clinicians should monitor for signs of bleeding throughout the duration of therapy.</jats:p>","journal":"The Senior Care Pharmacist","year":2023,"id":620944,"datarank":0.20794415416798362,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.0,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1603127,"name":"Sharon See","orcid":null,"position":1,"is_corresponding":false},{"id":1603125,"name":"Jason Ifeanyi","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"A Review of the Safety and Efficacy of Apixaban in Patients With Severe Renal Impairment","abstract":"<jats:p><jats:bold>Background</jats:bold> Apixaban is a direct-acting oral anticoagulant (DOAC) used to treat or prevent thromboembolic events. Renal impairment limits DOAC use. Studies supporting Food and Drug Administration (FDA)-approval for apixaban did not include patients with a creatinine clearance\n &lt; 25 mL/min. Consequently, limited guidance for use in end-stage renal disease (ESRD) exists in the package insert. An in-depth literature search reveals substantial evidence supporting the safety and effectiveness of apixaban in ESRD. Clinicians must have access to this evidence so that\n patients in need of apixaban therapy are appropriately managed.  <jats:bold>Objective</jats:bold> To provide an up-to-date review of literature surrounding the safety and effectiveness of apixaban in patients with ESRD.  <jats:bold>Data Sources</jats:bold> A PubMed search of research studies published\n through November 2021 was performed using a combination of the following terms: apixaban, severe renal impairment, end-stage renal disease, DOACs, safety, effectiveness, atrial fibrillation, anticoagulation.  <jats:bold>Study Selection/Data Extraction</jats:bold> Relevant original research, review\n articles, and guidance recommendations were assessed for the use of apixaban in patients with ESRD. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results.  <jats:bold>Data Synthesis</jats:bold>\n Numerous studies exist supporting the safety and effectiveness of apixaban in patients with ESRD who may or may not be on dialysis.  <jats:bold>Conclusion</jats:bold> Multiple studies suggest that apixaban is possibly associated with a lower prevalence of bleeding and thromboembolic events\n compared with warfarin therapy in patients with ESRD and can be safely initiated in those within this sub-group who require anticoagulation with a DOAC. Clinicians should monitor for signs of bleeding throughout the duration of therapy.</jats:p>","is_dataset_classified":null,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"36803700","pmcid":null,"openalex_id":"https://openalex.org/W4321478334","authors":[],"funders":[],"total_grants":0,"fwci":0.5404,"citation_percentile":0.66245348,"influential_citations":0,"citation_trend":[{"year":2023,"count":1},{"year":2024,"count":2}],"oa_status":"closed","license":null,"oa_locations":[{"url":"https://www.ingentaconnect.com/content/ascp/tscp/2023/00000038/00000003/art00004","host_type":"publisher"},{"url":"https://doi.org/10.4140/tcp.n.2023.86","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/36803700","host_type":"repository"}],"fields_of_study":["Atrial Fibrillation Management and Outcomes","Cardiac Arrhythmias and Treatments","Cardiac electrophysiology and arrhythmias","Humans","Warfarin","Anticoagulants","Pyridones","Hemorrhage","Kidney Failure, Chronic","Renal Insufficiency","Pyrazoles"],"mesh_terms":["Anticoagulants","Hemorrhage","Humans","Kidney Failure, Chronic","Pyrazoles","Pyridones","Warfarin","Renal Insufficiency"],"keywords":["Apixaban","Medicine","End stage renal disease","Intensive care medicine","Dialysis","Atrial fibrillation","Warfarin","Stroke (engine)","Dabigatran","Disease","Internal medicine","Rivaroxaban"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-03T12:39:54.875630Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}