Risk of bleeding with factor Xa inhibitors versus unfractionated heparin in patients with acute kidney injury.

Study Objective: 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). Design: Single‐center, retrospective, observational study. Setting: Ascension St. John Hospital in Detroit, Michigan. Patients 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. Measurements and Main Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

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