Safety of apixaban compared to warfarin in hemodialysis patients: Do antiplatelets make a difference?
Administration, Oral
Anticoagulants
/ administration & dosage
Blood Coagulation
/ drug effects
Blood Platelets
/ drug effects
Factor Xa Inhibitors
/ administration & dosage
Female
Health Care Surveys
Hemorrhage
/ epidemiology
Humans
Kidney Failure, Chronic
/ complications
Male
Pyrazoles
/ administration & dosage
Pyridones
/ administration & dosage
Renal Dialysis
/ adverse effects
Risk Assessment
Warfarin
/ administration & dosage
anticoagulation
apixaban
atrial fibrillation
direct oral anticoagulant
end-stage renal disease
hemodialysis
venous thromboembolism
warfarin
Journal
European journal of haematology
ISSN: 1600-0609
Titre abrégé: Eur J Haematol
Pays: England
ID NLM: 8703985
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
revised:
06
02
2021
received:
08
12
2020
accepted:
09
02
2021
pubmed:
12
2
2021
medline:
15
12
2021
entrez:
11
2
2021
Statut:
ppublish
Résumé
Data on the safety of apixaban compared to warfarin in hemodialysis (HD) patients are accumulating, but the impact of concomitant antiplatelet use is unknown. Compare hemorrhagic risk and impact of antiplatelets in HD patients receiving oral anticoagulants (OAC). Retrospective, multi-center study of HD patients started on OAC inpatient over 5 years. 707 patients were included: 563 received warfarin, and 144 received apixaban. 197 had bleeding, most in the warfarin group (173 [30.1%] vs 24 [16.7%] in the apixaban group), P-value < .01). However, with concomitant antiplatelet use, frequencies were similar (31.4% vs 25.0%; P-value = .292). Cumulative incidence using bleeding as event of interest and death as competing risk showed higher rates of bleeding with warfarin. In a multivariate model, apixaban was associated with a lower hemorrhagic risk (hazard ratio [HR] 0.55 [95% confidence interval {CI} 0.35-0.86}). Apixaban showed lower hemorrhagic risk alone (HR 0.24, 95% CI 0.10-0.55) and similar risk when administered with antiplatelets (HR 0.93, 95% CI 0.55-1.56). Apixaban is associated with less bleeding in HD patients compared to warfarin, but concomitant antiplatelet use may negate the safety advantage. Prospective trials are warranted to determine the impact of antiplatelets on apixaban safety.
Sections du résumé
BACKGROUND
BACKGROUND
Data on the safety of apixaban compared to warfarin in hemodialysis (HD) patients are accumulating, but the impact of concomitant antiplatelet use is unknown.
OBJECTIVES
OBJECTIVE
Compare hemorrhagic risk and impact of antiplatelets in HD patients receiving oral anticoagulants (OAC).
METHODS
METHODS
Retrospective, multi-center study of HD patients started on OAC inpatient over 5 years.
RESULTS
RESULTS
707 patients were included: 563 received warfarin, and 144 received apixaban. 197 had bleeding, most in the warfarin group (173 [30.1%] vs 24 [16.7%] in the apixaban group), P-value < .01). However, with concomitant antiplatelet use, frequencies were similar (31.4% vs 25.0%; P-value = .292). Cumulative incidence using bleeding as event of interest and death as competing risk showed higher rates of bleeding with warfarin. In a multivariate model, apixaban was associated with a lower hemorrhagic risk (hazard ratio [HR] 0.55 [95% confidence interval {CI} 0.35-0.86}). Apixaban showed lower hemorrhagic risk alone (HR 0.24, 95% CI 0.10-0.55) and similar risk when administered with antiplatelets (HR 0.93, 95% CI 0.55-1.56).
CONCLUSIONS
CONCLUSIONS
Apixaban is associated with less bleeding in HD patients compared to warfarin, but concomitant antiplatelet use may negate the safety advantage. Prospective trials are warranted to determine the impact of antiplatelets on apixaban safety.
Substances chimiques
Anticoagulants
0
Factor Xa Inhibitors
0
Pyrazoles
0
Pyridones
0
apixaban
3Z9Y7UWC1J
Warfarin
5Q7ZVV76EI
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
689-696Informations de copyright
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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