Scientific Poster Session IV- Late Breaking Original Research

Abstract

Apixaban usage has grown steadily over the past decade. While guidance exist for chronic renal dysfunction, evidence is limited for acute kidney injury (AKI).

Research Question or Hypothesis:

Is continuing apixaban versus switching to unfractionated heparin (UFH) in patients with AKI associated with fewer bleeding events without a difference in thromboembolic events?

Study Design:

This retrospective cohort study compared the bleeding and thromboembolic events in apixaban treated patients receiving apixaban or switched to UFH after developing an AKI (AKIN Criteria II or III).

Methods:

Patients admitted between 2018 and 2023 who received apixaban or UFH for = 24 hours in the setting of AKI were compared. The primary outcome was composite bleeding rates. Secondary outcomes included major bleeds, clinically relevant non-major bleeds, thromboembolic events, length of stay, and mortality. Demographics, medications, labs, and documentation related to bleeding and thromboembolic events were collected. Demographic and outcome data were analyzed using Mann-Whitney U test and Chi-squared test or Fisher’s exact test.

Results:

Medical records of 771 patients were screened and 110 patients included; 76 (69%) in the apixaban group and 34 (31%) in the heparin group. The heparin group had more patients admitted to the ICU, higher IMPROVE Bleed scores, and higher peak serum creatinine. There was no significant difference in bleeding proportions between apixaban and heparin groups (19.7% vs 14.7%, p = 0.527). Fewer thromboembolic events were noted in the apixaban group (0% vs 5.9%, p = 0.035). Apixaban-treated patients also experienced shorter hospital stays (7.62 vs 12.11 days, p = 0.018) and lower mortality (7.9% vs 29.4%, p = 0.003) compared to those switched to heparin.

Conclusion:

Patients continued on apixaban after an AKI had no difference in bleeding rates than if they were switched to heparin. However, patients switched to heparin had higher rates of thromboembolism. Further research with larger cohorts is needed to establish a correlation.

Presenting Author

Authors