Outcomes Associated With Apixaban Use in Patients With End-Stage Kidney Disease and Atrial Fibrillation in the United States

Siontis, Konstantinos C.; Zhang, Xiaosong; Eckard, Ashley; Bhave, Nicole M.; Schaubel, Douglas E.; He, Kevin; Tilea, Anca; Stack, Austin G.; Balkrishnan, Rajesh; Yao, Xiaoxi; Noseworthy, Peter A.; Shah, Nilay D.; Saran, Rajiv; Nallamothu, Brahmajee K.

doi:10.1161/circulationaha.118.035418

Cited by 383 publications

(341 citation statements)

References 38 publications

(50 reference statements)

Supporting

Mentioning

303

Contrasting

Unclassified

Order By: Relevance

“…We observed similar rates of major bleeding in CKD IV/V patients with DOAC use in our study. Other recent studies have similarly shown a comparable or lower risk of bleeding with DOACs when compared with warfarin in ESRD patients …”

Section: Discussionmentioning

confidence: 70%

“…However, the DOAC trials excluded patients with severe CKD or ESRD, and support for their use is limited primarily to pharmacologic studies (http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/202439s001lbl.pdf). A study comparing warfarin with apixaban in dialysis patients suggested that apixaban was both effective and safe in these patients . This study utilized a national database, and prior studies with patient‐level data focused primarily on safety rather than efficacy …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease

Bhatia

Bailey

Ünlü

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background Direct oral anticoagulants (DOACs) are effective alternatives to warfarin for stroke prevention in patients with atrial fibrillation (AF) including patients with CKD III. However, data on patient outcomes with DOACs for advanced CKD are limited, while warfarin use is controversial. Methods A retrospective study of patients with AF using DOACs and CKD stages III‐V was conducted. The primary outcomes were stroke or systemic embolism and major bleeding while on DOAC therapy among CKD IV and V patients. Rates of outcomes from the DOAC trials and from previous studies of warfarin in CKD were referenced. Results Of 316 patients reviewed, 152 were included with mean CrCl of 38.8 mL/min. Stroke and systemic embolism occurred at a rate of 1.17 per 100 person‐years, with no significant difference between CKD IV/V and CKD III (P = .567). Rates were comparable to DOAC use from the DOAC trials, and lower than rates in studies of warfarin in CKD IV/V patients. There was a nonstatistically significant trend toward increased major bleeding in CKD IV/V patients. Rates of major bleeding in CKD III to V subjects were comparable to published rates for warfarin users with similar levels of renal impairment. Conclusions In our study, DOACs appeared to be as efficacious and safe in CKD IV and V as in CKD III. In addition, DOACs appeared to be more effective than, and as safe as warfarin when compared with reference studies of patients with advanced CKD. Our findings support the use of DOACs for thromboembolism prevention in patients with advanced CKD and AF.

show abstract

Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease

Bhatia

Bailey

Ünlü

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…Rivaroxaban and dabigatran undergo renal clearance to a greater extent than apixiban (80% and 33%, respectively) and their use in ESRD is associated with increased incidence of fatal bleeding events . Observational data from Medicare beneficiaries suggests that apixiban may be associated with a lower risk of major bleeding in patients with AF and ESRD . However these data are hypothesis generating and need confirmation in prospective randomized trials.…”

Section: Laac and Doac In Unique Subgroupsmentioning

confidence: 99%

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

Black‐Maier

Piccini

Granger

2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and confers a fivefold increased risk for stroke. Cardioembolic stroke secondary to AF is a devastating event, but is largely preventable with appropriate oral anticoagulation (OAC). The PROTECT and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage closure (LAAC) device in combination with short‐term warfarin therapy is noninferior to long‐term warfarin with respect to a composite endpoint of stroke, cardiovascular death, and systemic embolism. Importantly, the WATCHMAN confers a significant reduction in life‐threatening bleeding compared to OAC. Although direct‐acting oral anticoagulant (DOAC) are superior to warfarin in eligible patients, several important AF populations exist in whom left atrial appendage (LAA) closure may be preferable to DOAC. Populations warranting strong consideration of LAAC include patients with contraindications to DOAC, end‐stage renal disease, prior intracranial hemorrhage, recurrent gastrointestinal bleeding, and patients undergoing transcatheter aortic valve replacement or left atrial electrical isolation. Device‐related thrombosis is an important complication of LAAC, and DOAC may be preferential to warfarin for prevention and treatment of this complication remains unexplored. Prospective clinical trials comparing DOAC to LAAC in these unique populations are either ongoing or needed.

show abstract

“…Compared with warfarin, all four NOACs showed consistent efficacy and safety in patients with mild to moderate CKD . In an observational study of >25 000 patients with AF on dialysis showed that the discontinuation rates were high, and only one‐third of patients were taking the anticoagulant 12 months after the initial prescription …”

Section: Real World Stroke Prevention Strategies In Nonvalvular Atriamentioning

confidence: 99%

Research update for articles published in EJCI in 2017

Arellano-Orden

Bacopoulou

Băicuș

et al. 2019

Eur J Clin Investigation

View full text Add to dashboard Cite

Outcomes Associated With Apixaban Use in Patients With End-Stage Kidney Disease and Atrial Fibrillation in the United States

Abstract: Among patients with ESKD and AF on dialysis, apixaban use may be associated with a lower risk of major bleeding compared with warfarin, with a standard 5 mg twice a day dose also associated with reductions in thromboembolic and mortality risk.

Cited by 383 publications

References 38 publications

Efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease

Efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

Research update for articles published in EJCI in 2017

Contact Info

Product

Resources

About