Department of Pharmacy, Ascension St. John Hospital, Detroit, Michigan, USA.
Department of Pharmacy, Wayne State University Eugene Applebaum Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan, USA.
Pharmacotherapy. 2023 Feb;43(2):129-135. doi: 10.1002/phar.2759. Epub 2023 Jan 6.
To compare bleeding and thromboembolic events in patients receiving therapeutic doses of apixaban or rivaroxaban versus unfractionated heparin (UFH) in patients with acute kidney injury (AKI).
Single-center, retrospective, observational study.
Ascension St. John Hospital in Detroit, Michigan.
Hospitalized adult patients who received therapeutic doses of factor Xa inhibitors (n = 250) or UFH (n = 250) for at least 24 h in the setting of AKI.
After adjusting for confounding factors, patients who received a factor Xa inhibitor experienced a lower risk of composite major and clinically relevant nonmajor bleeding (CRNMB) events compared with UFH (OR: 0.57, 95% CI: 0.34-0.94; p = 0.03). There was a significantly decreased risk of CRNMB events in the factor Xa inhibitor group (OR: 0.55, 95% CI: 0.33-0.91, p = 0.02); however, no significant differences in major bleeding or venous thromboembolism (VTE) were noted.
Our results suggest that it may be preferable to continue patients in AKI on factor Xa inhibitors versus transitioning to UFH due to the lower risk of bleeding events.
比较急性肾损伤（AKI）患者接受治疗剂量的阿哌沙班或利伐沙班与未分级肝素（UFH）治疗时的出血和血栓栓塞事件。
单中心、回顾性、观察性研究。
密歇根州底特律 Ascension St. John 医院。
接受至少 24 小时治疗剂量的 Xa 因子抑制剂（n=250）或 UFH（n=250）治疗的 AKI 住院成年患者。
在调整混杂因素后，与 UFH 相比，接受 Xa 因子抑制剂治疗的患者发生复合主要和临床相关非重大出血（CRNMB）事件的风险较低（OR：0.57，95%CI：0.34-0.94；p=0.03）。Xa 因子抑制剂组 CRNMB 事件的风险显著降低（OR：0.55，95%CI：0.33-0.91，p=0.02）；然而，主要出血或静脉血栓栓塞（VTE）没有显著差异。
我们的研究结果表明，由于出血事件风险较低，与转换为 UFH 相比，继续在 AKI 中使用 Xa 因子抑制剂可能是更好的选择。
