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  3. Impact of Renal Function on Apixaban and Rivaroxaban Use in Stroke Pat…
Systematic Review Open Access

Impact of Renal Function on Apixaban and Rivaroxaban Use in Stroke Patients with Atrial Fibrillation

, , , , , , , , , ,
* Correspondence: [email protected]
Annals of Medicine and Medical Sciences Volume 04 (2025), Version 12 October 31, 2025 pp. 1291 -1302
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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 the 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 requires 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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