Research appearing in the Journal of American Medical Association indicates that for patients suffering from atrial fibrillation and advanced chronic kidney disease who are not on dialysis, taking anticoagulation medication lowers the chance of ischemic stroke while raising the danger of bleeding.
The study evaluated the safety and efficacy of apixaban compared to warfarin and no oral anticoagulant usage in patients with advanced chronic kidney disease and atrial fibrillation who are not undergoing dialysis.
Researchers analyzed data from Medicare fee-for-service claims and the Optum deidentified Clinformatics Data Mart database, including 14,712 apixaban users, 6,335 warfarin users, and 21,005 nonusers of oral anticoagulants.
The study found that apixaban was linked to a decreased risk of ischemic stroke, with a weighted hazard ratio of 0.46 and a 95% confidence interval of 0.32–0.66, but a greater risk of serious bleeding, with a weighted hazard ratio of 1.32 and a 95% confidence interval of 1.11–1.58, compared to nonusers of oral anticoagulants.
Apixaban was also found to decrease the risk of significant bleeding and ischemic stroke when compared to warfarin, which raised the composite outcome and was linked to a considerably greater risk of serious bleeding without significantly lowering ischemic stroke.
In comparison to warfarin, apixaban was linked to lower ischemic stroke and higher major bleeding than nonuse, while warfarin was linked to higher major bleeding and no significant decrease in ischemic stroke among patients with atrial fibrillation and chronic kidney disease stage 4 or 5 who were not receiving dialysis.
According to the study, apixaban was favored over nonuse by tipping-point analyses, indicating its potential benefits in reducing the risk of ischemic stroke and bleeding in this patient population.
The study, which analyzed data from February 2025 to June 2026, included patients with mean ages of 78.93, 77.47, and 79.59 years for apixaban users, warfarin users, and nonusers of oral anticoagulants, respectively, and was published in JAMA Network Open, 9(9), e2632225, https://doi.org/10.1001/jamanetworkopen.2026.32225, highlighting the importance of considering the benefits and risks of anticoagulation therapy in this patient population.
