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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

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
  • Garlo, Katherine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
  • Charytan, David M., New York University School of Medicine, Bronx, New York, United States
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