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Safety and effectiveness of apixaban compared to warfarin in dialysis patients.

Authors:
Daniel Reed Surabhi Palkimas Rebecca Hockman Sumner Abraham Tri Le Hillary Maitland

Res Pract Thromb Haemost 2018 Apr 26;2(2):291-298. Epub 2018 Mar 26.

Division of Hematology & Oncology University of Virginia Charlottesville VA USA.

The use of apixaban for stroke prophylaxis or for the treatment of venous thromboembolism in end stage renal disease (ESRD) patients maintained on dialysis is based on one single-dose pharmacokinetic study. There is a deficiency of clinical evidence supporting safety in this population. The purpose of this study was to determine the safety and efficacy of apixaban compared with warfarin in dialysis patients. This is a retrospective cohort study conducted at the University of Virginia Medical Center. A total of 124 ESRD patients maintained on dialysis who either received apixaban (n = 74) or warfarin (n = 50) between January 1, 2014 and October 31, 2016 were included in the study. We used multivariable logistic regression to compare the likelihood of patients experiencing a bleeding event based on anticoagulant therapy. The apixaban group experienced fewer overall bleeding events than the warfarin group (18.9% vs 42.0%; =.01); this significant difference persisted in adjusted analysis (OR = 0.15; 95% CI = 0.05-0.46; =.001). Major bleeding events were less frequent in the apixaban group compared with patients on warfarin (5.4% vs 22.0%; =.01). There were no recurrent ischemic strokes in either groups. A lower, non-significant, incidence of recurrent VTE was found in patients on apixaban compared with warfarin (4.4% vs 28.6%; =.99). Compared to warfarin, our findings suggest that apixaban is a safe and effective alternative in patients with ESRD maintained on dialysis, with apixaban patients experiencing fewer bleeding events than warfarin patients.

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http://dx.doi.org/10.1002/rth2.12083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055495PMC
April 2018

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