Impact of Renal Function on Apixaban and Rivaroxaban Use in Stroke Patients with Atrial Fibrillation
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Abstract
Objective: To assess how renal function influences the efficacy and safety of apixaban and rivaroxaban in patients with atrial fibrillation (AF) and chronic kidney disease (CKD). Design: Systematic review following PRISMA guidelines. Methods: A comprehensive literature search identified studies published between 2018 and 2024 evaluating apixaban or rivaroxaban use in AF patients with varying degrees of renal impairment. Twenty-six studies meeting inclusion criteria were reviewed for outcomes related to stroke prevention, bleeding risk, and dose adjustment. Results: Apixaban and rivaroxaban were both effective in stroke prevention among AF patients with CKD. However, apixaban consistently demonstrated a superior safety profile, with lower rates of major bleeding, particularly in patients with moderate to severe CKD or on dialysis. This benefit is attributed to apixaban’s lower renal clearance compared with rivaroxaban, which often required dose modification in renal impairment. Most studies favored apixaban for patients with advanced CKD, while rivaroxaban use was associated with higher bleeding risk in severe renal dysfunction. Conclusion: Apixaban offers favorable safety and comparable efficacy to rivaroxaban in AF patients with CKD. Individualized anticoagulation strategies guided by renal function are essential, and further studies are warranted in end-stage renal disease populations.
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Copyright (c) 2025 Wilhelmina N. Hauwanga, Abisola M. Olowofeso, Amoolya R. Amaravadhi, Marwa Kdouk, Johny Davilma, Onyinye Ebiliekwe, Ifunanya R. Ekeocha, Abdelwahab Ahmed, Pranav Tiyyala, Hassan A. Ahmed, Billy McBenedict
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Wilhelmina N. Hauwanga, Cardiology, Faculty of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
Cardiology, Faculty of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
Abisola M. Olowofeso, Public Health, University of Illinois, Springfield, USA.
Public Health, University of Illinois, Springfield, USA.
Amoolya R. Amaravadhi, Internal Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, India.
Internal Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, India.
Marwa Kdouk, Neurosurgery, Fluminense Federal University, Niterói, Brazil.
Neurosurgery, Fluminense Federal University, Niterói, Brazil.
Johny Davilma, Internal Medicine, St Elizabeth Youngstown Hospital - Neomed, Youngstown, USA.
Internal Medicine, St Elizabeth Youngstown Hospital - Neomed, Youngstown, USA.
Onyinye Ebiliekwe, Neurosurgery, Fluminense Federal University, Niterói, Brazil.
Neurosurgery, Fluminense Federal University, Niterói, Brazil.
Ifunanya R. Ekeocha, Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Abdelwahab Ahmed, Internal Medicine, Kassala University Hospital, Kassala, Sudan.
Internal Medicine, Kassala University Hospital, Kassala, Sudan.
Pranav Tiyyala, Neurosurgery, Fluminense Federal University, Niterói, Brazil.
Neurosurgery, Fluminense Federal University, Niterói, Brazil.
Hassan A. Ahmed, Neurosurgery, Fluminense Federal University, Niterói, Brazil.
Neurosurgery, Fluminense Federal University, Niterói, Brazil.
Billy McBenedict, Neurosurgery, Fluminense Federal University, Niterói, Brazil.
Neurosurgery, Fluminense Federal University, Niterói, Brazil.
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