Kidney Week

Abstract: TH-OR098

Efficacy and Safety of the Standard and Reduced Apixaban Dose Compared with No Anticoagulation in Dialysis Patients with Newly Diagnosed Atrial Fibrillation

Session Information

• Hypertension and CVD: Therapies and Predictors
  November 07, 2019 | Location: 206, Walter E. Washington Convention Center
  Abstract Time: 04:30 PM - 04:42 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Mavrakanas, Thomas, Brigham & Women's Hospital, Harvard Medical School, Boston, United States

Thomas Mavrakanas, MD, MS, FASN



I obtained my Medical Degree from the Aristotle University of Thessaloniki in Greece. I was trained in Internal Medicine in Switzerland and practiced as a staff physician of the Internal Medicine Division at Geneva University Hospitals between 2012 and 2014. Then, I obtained a competitive scholarship of the Swiss National Science Foundation to pursue my training with the subspecialty of Nephrology at McGill University in Montreal, Canada, then a research fellowship at Brigham & Women’s Hospital, Harvard Medical School. I currently hold an attending staff appointment at Geneva University Hospitals and was recently appointed Privat-Docent (equivalent to assistant professor) at Geneva University. I am also Adjunct Professor of Medicine at McGill University and Research Collaborator at Brigham & Women’s Hospital, Harvard Medical School.

• Garlo, Katherine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

Katherine Garlo,

• Charytan, David M., New York University School of Medicine, Bronx, New York, United States

David M. Charytan,

Background

The relative efficacy and safety of apixaban compared with no anticoagulation for atrial fibrillation (AF) has not been studied in dialysis patients.

Methods

This retrospective cohort study utilized 2012-2015 United States Renal Data System data. Dialysis patients with incident, non-valvular AF treated with apixaban (521 patients) were matched for relevant baseline characteristics with patients not treated with any anticoagulant agent (1561 patients). Competing risk survival models were used.

Results

Compared with no anticoagulation, apixaban was not associated with reduced risk of stroke or thromboembolism: HR 1.23, 95% CI 0.68-2.20, p=0.49. A significantly higher incidence of fatal or intracranial bleeding was observed with apixaban compared with no treatment: HR 2.48, 95% CI 1.25-4.90, p=0.009. A higher rate of stroke or systemic thromboembolism (Figure) and fatal or intracranial bleeding was seen in the subgroup of patients treated with the standard apixaban dose (5 mg twice daily) but not with the reduced apixaban dose (2.5 mg twice daily). A similar incidence of clinically significant bleeding events and major cardiovascular events was seen with apixaban compared with no treatment.

Conclusion

Randomized studies are needed to assess the efficacy of apixaban compared with no anticoagulation in chronic dialysis. Awaiting randomized data, prudence in prescribing apixaban to dialysis patients, especially at the standard dose, is warranted.
Disclaimer The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US government.

Stroke or systemic embolism in patients treated with the standard and the reduced apixaban dose compared with no anticoagulation.

Funding

• Private Foundation Support