Comparison of Efficacy and Safety of Apixaban and Warfarin in Patients with Atrial Fibrillation and Chronic Kidney Disease: A Randomised Controlled Trial

Introduction: Atrial fibrillation (AF), the most common kind of cardiac arrhythmia, has a significant role in ischemic stroke and other severe thromboembolic consequences.According to current guidelines, individuals with atrial fibrillation who are at risk (CHA2DS2VASc score above or equal to 2) should receive direct oral anticoagulants (DOACs) instead of vitamin K inhibitors in order to avoid these dangerous side effects.The usefulness of apixaban for people with chronic kidney disease (CKD) without hemodialysis is still up for debate.Aims/ objective: To compare the efficacy and safety of apixaban versus warfarin in patients with AF and stage 3-5 chronic kidney disease. Materials and Method:Using web-generated random numbers, each patient with AF and CKD who met our eligibility requirements was assigned to either the warfarin (W) or apixaban (A) group.This was done through consecutive sampling.According to recommendations from the American College of Cardiology (ACC), anticoagulant medication dosages were adjusted.Incidences of ischemic stroke and thromboembolism within 1-year, significant bleeding within 3 months of enrolment and within 6 and 12 months of follow-up, and TTR (time in therapeutic range of INR between 2.0 -3.0) at 1 year were compared between two groups.Results: Incidence of major bleeding was lesser in patients on apixaban therapy as compared to patients receiving warfarin and the difference became significant at 12 months (p<0.05).Patients on apixaban therapy had longer duration in therapeutic range of INR (2.0-3.0) in comparison to patients on warfarin therapy and the difference was statistically significant (p<0.0001).Incidence of stroke and thromboembolism was also lower in patients given apixaban as compared to patients on warfarin therapy but the difference was not statistically significant at this sample size. Conclusion:apixaban medication reduced the risk of stroke and thrombosis in individuals with atrial fibrillation compared to those treated with warfarin.Moreover, apixaban, at both the conventional and reduced doses, does not increase the risk of serious bleeding when compared to warfarin.