Apixaban Dosing Patterns Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation Receiving Dialysis: A Retrospective Cohort Study

Wetmore, James B.; Weinhandl, Eric D.; Yan, Heng; Reyes, Jorge L.; Herzog, Charles A.; Roetker, Nicholas S.

doi:10.1053/j.ajkd.2022.03.007

Cited by 28 publications

(32 citation statements)

References 29 publications

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“…A Japanese study by Koretsune et al found that apixaban reduced the risk of SSE in patients with a CrCl 15-49 ml/min compared with warfarin [34]. In a haemodialysis population there were four studies comparing DOACs to warfarin [35][36][37][38]. A RCT studied rivaroxaban 10 mg daily in a haemodialysis population and found a reduction in SSE with rivaroxaban but this study was not powered to detect a difference in stroke [35].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…A RCT studied rivaroxaban 10 mg daily in a haemodialysis population and found a reduction in SSE with rivaroxaban but this study was not powered to detect a difference in stroke [35]. The use of apixaban in two retrospective studies of dialysis patients found no significant reduction in stroke compared to those on warfarin, with patients taking apixaban 2.5 mg or 5 mg twice daily [36,38]. Conversely, in a haemodialysis population, Chan et al found that rivaroxaban and dabigatran had an increased risk of embolic stroke and arterial embolism compared to warfarin [37].…”

Section: Study Characteristicsmentioning

confidence: 99%

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A systematic review of the efficacy and safety of anticoagulants in advanced chronic kidney disease

et al. 2022

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Background Patients with chronic kidney disease (CKD) have an increased risk of venous thromboembolism (VTE) and atrial fibrillation (AF). Anticoagulants have not been studied in randomised controlled trials with CrCl < 30 ml/min. The objective of this review was to identify the impact of different anticoagulant strategies in patients with advanced CKD including dialysis. Methods We conducted a systematic review of randomized controlled trials and cohort studies, searching electronic databases from 1946 to 2022. Studies that evaluated both thrombotic and bleeding outcomes with anticoagulant use in CrCl < 50 ml/min were included. Results Our initial search yielded 14,503 papers with 53 suitable for inclusion. RCTs comparing direct oral anticoagulants (DOACs) versus warfarin for patients with VTE and CrCl 30-50 ml/min found no difference in recurrent VTE events (RR 0.68(95% CI 0.42–1.11)) with reduced bleeding (RR 0.65 (95% CI 0.45–0.94)). Observational data in haemodialysis suggest lower risk of recurrent VTE and major bleeding with apixaban versus warfarin. Very few studies examining outcomes were available for therapeutic and prophylactic dose low molecular weight heparin for CrCl < 30 ml/min. Findings for patients with AF on dialysis were that warfarin or DOACs had a similar or higher risk of stroke compared to no anticoagulation. For patients with AF and CrCl < 30 ml/min not on dialysis, anticoagulation should be considered on an individual basis, with limited studies suggesting DOACs may have a preferable safety profile. Conclusion Further studies are still required, some ongoing, in patients with advanced CKD (CrCl < 30 ml/min) to identify the safest and most effective treatment options for VTE and AF.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

A systematic review of the efficacy and safety of anticoagulants in advanced chronic kidney disease

et al. 2022

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“…Small-molecule drugs mainly refer to organic compounds with molecular weights less than 1000, and they have been widely used and mature in theory [ 113 , 114 , 115 , 116 , 117 ]. Apixaban, widely used in clinical practice, is a small molecule drug whose main mechanism is to inhibit the expression of FXa [ 118 , 119 , 120 , 121 , 122 ]. Researchers have discovered many small-molecule drugs that can inhibit gastric cancer progression by targeting HIF ( Table 8 ).…”

Section: Small Molecule Drugs Targeting Hif To Inhibit Gastric Cancermentioning

confidence: 99%

HIF in Gastric Cancer: Regulation and Therapeutic Target

Guan

Yang

et al. 2022

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HIF means hypoxia-inducible factor gene family, and it could regulate various biological processes, including tumor development. In 2021, the FDA approved the new drug Welireg for targeting HIF-2a, and it is mainly used to treat von Hippel-Lindau syndrome, which demonstrated its good prospects in tumor therapy. As the fourth deadliest cancer worldwide, gastric cancer endangers the health of people all across the world. Currently, there are various treatment methods for patients with gastric cancer, but the five-year survival rate of patients with advanced gastric cancer is still not high. Therefore, here we reviewed the regulatory role and target role of HIF in gastric cancer, and provided some references for the treatment of gastric cancer.

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“…In this issue of AJKD, Wetmore et al 8 present results from a retrospective cohort study that examined patient outcomes with nonvalvular AF treatment with warfarin versus apixaban at different doses among patients receiving maintenance dialysis who do not meet criteria for reduced apixaban dosing. Using data from the US Renal Data System, investigators identified adults with a diagnosis code for nonvalvular AF who initiated either warfarin or apixaban between April 2013 and December 2018.…”

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confidence: 99%

“…Similar findings were noted in analyses that censored at drug discontinuation or drug change. 8 It is important that Wetmore et al conducted analyses that address the dynamics of medication use in patients receiving dialysis. As shown in their Table S6, more than half of all patients in this study discontinued the prescribed anticoagulant regardless of drug or dose.…”

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confidence: 99%