Background: Thromboembolic events, principally stroke, represent one of the
leading causes of morbidity and mortality among subjects with atrial fibrillation. Chronic
kidney disease determines a further increase of thromboembolic events, bleeding and mortality
and complicates the pharmacological management of patients with atrial fibrillation,
mainly due to the side effects of antiarrhythmic and anticoagulant drugs with renal excretion.
Apixaban is a new oral anticoagulant characterized by good bioavailability and renal
elimination accounting for only 25%, showing a safety profile and effectiveness in patients
with renal impairment.
Objective: In this manuscript, we reviewed literature data on the use of apixaban in the
management of non-valvular atrial fibrillation in patients with renal failure, in order to
clarify an often-debated topic in clinical practice.
Method: A PubMed search was performed on the terms atrial fibrillation, apixaban and renal
failure with the aim of identifying relevant manuscripts, large randomized clinical trials,
meta-analyses, and current guidelines.
Results: Literature data show that apixaban could represent an interesting alternative to
warfarin and other selective antagonists of coagulation factors in patients with impaired
renal function. About the risk of major bleeding, apixaban appears to be safer than warfarin
in the presence of any degree of renal failure.
Conclusion: Apixaban show to be an effective anticoagulant in patients with atrial fibrillation,
even superior to warfarin in reducing the risk of stroke and systemic embolism regardless
of the presence of renal insufficiency. Moreover, Food and Drug Administration
allows the use of apixaban in patients with end stage renal disease on hemodialysis.