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Among patients with atrial fibrillation and dialysis-dependent end stage renal disease, apixaban was badociated with a lower hemorrhagic risk than warfarin, reported the researchers.
In a sensitivity badysis, the standard 5 mg twice-daily dose of apixaban (Eliquis, Bristol-Myers Squibb / Pfizer) was also badociated with a lower risk of thromboembolism and mortality than warfarin in this population
"This is the first data showing that apixaban is potentially safer than warfarin in dialysis patients." fibrillation, " Konstantinos C. Siontis, MD, who at the time The study was a cardiovascular fellow at the Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, and is now affiliated with the Department of Cardiovascular Medicine at Mayo Clinic, said in a press release. "We found that patients on apixaban had a significantly lower risk of major bleeding with no difference in stroke, which we are trying to prevent by prescribing these anticoagulants."
Siontis and colleagues conducted a retrospective cohort study of 25,523 patients, 68 years, 46% of women) who were Medicare beneficiaries included in the US renal data system. Of the cohort, 2,351 patients were taking apixaban and the rest were taking warfarin for the prevention of stroke because of AF. The 2,351 patients taking apixaban were matched on a 1: 3 basis to 7,053 patients taking warfarin based on the propensity score.
Results of interest included survival without stroke or systemic embolism, major bleeding, gastrointestinal bleeding, intracranial bleeding and mortality.
Siontis and colleagues found no significant difference between groups in stroke / systemic embolism (HR = 0.88;% CI, 0.69-1.12), but the group apixaban had a lower risk of major bleeding (HR = 0.72, 95% CI, 0.59-0.87).
There was no difference in the risk of intracranial bleeding (HR = 0.79, 95% CI, 0.49-1.26), but there was a tendency favoring apixaban in the risk of gastrointestinal bleeding (HR = 0.86, 95% CI, 0.72-1.02 For sensitivity badyzes, the researchers compared apixaban 5 mg twice daily with l & # 39; Apixaban 2.5 mg twice a day and warfarin.They found apixaban 5 mg twice daily conferred a lower risk of stroke / systemic embolism (HR vs apixaban 2.5 mg twice daily = 0.61, 95% CI, 0.37-0.98, HR vs. warfarin = 0.64, 95% CI, 0.42-0.97) and death (HR vs. apixaban 2.5 mg twice day = 0.64, 95% CI, 0.45-0.92, HR vs. warfarin = 0.63, 95% CI, 0.46-0.85).
"It is useful for clinicians to this information Now that we are waiting for the results of important randomized trials that are ongoing and to compare warfarin with apixaban in patients dialysis, "said Siontis in the version. "The combination of dialysis with atrial fibrillation is difficult, but as we learn more from clinical data and clinical trials, we hope that decision making will be better informed in the near future for the benefit of these patients. " – by Erik Swain
Disclosure s : The authors do not report any relevant financial disclosure.
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