Are Direct Oral Anticoagulants Safe in Patients with End-Stage Renal Disease?

The answer might be yes, according to a retrospective analysis of dialysis patients with atrial fibrillation prescribed apixaban.

Patients with atrial fibrillation (AF) and end-stage renal disease (ESRD) who are on dialysis have elevated risks for thromboembolic events and bleeding. The FDA, relying solely on pharmacokinetic data, approved standard-dose apixaban in dialysis patients in 2012. For real-world insights, investigators analyzed 2010–2015 data from the U.S. Renal Data System on 25,523 patients with ESRD on dialysis who began oral anticoagulation (apixaban or warfarin). Patients were matched on a prognostic score for each outcome (apixaban, 2351 patients; warfarin, 7053 patients).

Following the FDA's apixaban approval, new prescriptions for ESRD patients with AF increased annually. Overall, the risk of stroke/systemic emboli was 11.9 per 100 person-years. Risk…

Reviewing Author

Fatima Rodriguez, MD, MPH

Disclosures

Consultant/Advisory BoardNovoNordisk; HealthPals; Novartis; Amgen

EquityHealthPals; Carta

Grant/Research SupportNational Institutes of Health/National Heart, Lung, and Blood Institute; American Heart Association–Robert Wood Johnson Foundation

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