Name: Safety evaluation of apixaban indicated for venous thromboembolism in patients with acute kidney injury
Start: 2025-04-24T10:10:00-0400
End: 2025-04-24T10:25:00-0400

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Thursday April 24, 2025 10:10am - 10:25am EDT

Parthenon 2

Title: Safety evaluation of apixaban indicated for venous thromboembolism in patients with acute kidney injury

Authors: Randall Parat, Mitchell Hutson, J. Morgan Knight, Meg Francis, Skyler Brown

Background: Apixaban, a factor Xa inhibitor used in multiple thromboembolic conditions, is approximately 30% renally eliminated and may accumulate in acute kidney injury (AKI). A dose reduction is commonly utilized in patients taking apixaban for atrial fibrillation, however, no current dose reduction is accepted for the treatment of venous thromboembolism (VTE). This study aimed to compare the frequency of major bleeding events in patients with or without acute kidney injury, who are taking apixaban for the treatment of acute or chronic venous thromboembolism.

Methods: This retrospective cohort study included patients admitted from January 2019 to December 2023 at a large academic medical center in Tennessee, USA. Two sets of patient encounters were gathered via chart documentation and ICD-10 codes. The control group with encounters containing documented VTE on apixaban, and the AKI group with encounters containing documented VTE on apixaban with AKI. The primary outcome evaluated was the incidence of a major bleeding event within three days of four consecutive apixaban doses. Secondary outcomes included the incidence of non-major bleeding events.

Results: 195 patients were included in this study, 103 in the control group and 92 in the AKI group. The incidence of major bleeding in the control group was 5 (4.9%) vs 3 (3.3%) in the AKI group (p = 0.724). Within the sample, 145 (74.4%) patients had an acute pulmonary embolism or acute deep vein thrombosis and the median number of apixaban doses including both loading and maintenance doses was 9 (IQR: 6-15). Within the AKI group, stage 1 AKIs were the most common occurring in 42 (45.7%) patients with a total median duration of AKI being 4 days (IQR: 2-7). The median length of stay was 9 days (IQR: 5-18).

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