ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: TH-PO252

Temporal Trend of Direct Oral Anticoagulant vs. Vitamin K Antagonist Usage in Dialysis Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Shaheed, Tariq A., The Permanente Medical Group, Berkeley, California, United States
  • Stram, Douglas A., The Permanente Medical Group, Berkeley, California, United States
  • Shirazi, Aida, The Permanente Medical Group, Berkeley, California, United States
  • Iwasaki, Sumie, The Permanente Medical Group, Berkeley, California, United States
  • Zheng, Sijie, The Permanente Medical Group, Berkeley, California, United States

Group or Team Name

  • The Permanente Medical Group, Kaiser Oakland Hospital, Kaiser San Francisco Hospital, and the Division of Research, California.
Background

Many dialysis patients take anticoagulation for various indications such as stroke prevention in atrial fibrillation, DVT and/or PE. Vitamin K antagonist (VKA) has been used for decades and Direct Oral Anticoagulants (DOAC) have gradually replaced VKA in the general population due to its ease of use. However, due to its safety issue in dialysis patients, the adoption of DOAC has been slow, until the approval of Apixaban by FDA in advanced CKD patients. In this study, we examined the temporal trend of anticoagulant usage in dialysis patients in an integrated health care system.

Methods

This is a retrospective cohort study performed within Kaiser Permanente Northern California (KPNC) from 2013-2021. Pharmacy records and ICD codes identified patients on dialysis (hemodialysis or peritoneal dialysis) who are taking oral anticoagulants to determine the percentage of dialysis patients on anticoagulants. Next, we determined the percent of patients on VKA and a DOAC. The percentage of patients on these two anticoagulants were determined every year.

Results

We identified 1688 dialysis patients on anticoagulants in the study period, representing 16.5% of dialysis populations (10242). In this population, mean age was 68.3 (SD 12.7), 40% female, 41% white, 21% Asian, 18% Hispanic, 15% Black and 6% others. There is an increase in the prescribing trends of DOAC with concurrent decrease in prescribing of VKAs (apixaban increased from 0 % in 2013 to 5.4 % in 2021 while warfarin decreased from 14.5% in 2013 to 9.8% in 2021 (figure). If a patient was to be switched off anticoagulation, they were more likely to be switched off VKA rather than apixaban.

Conclusion

This study revealed a diverging trend in the prescribing of VKA and DOAC over the past 9 years. Prescribers were more likely to switch from VKA to DOAC. Study is ongoing comparing the efficacy, safety, and cost.