Key result
Apixaban fails to reduce stroke in AF dialysis patients but is linked to more fatal bleeding.
Why the study?
The relative efficacy and safety of apixaban compared with no anticoagulation had not been studied in patients on maintenance dialysis with atrial fibrillation.
Does apixaban reduce hospital admission for a new stroke, transient ischemic attack, or systemic thromboembolism in patients on maintenance dialysis with incident nonvalvular atrial fibrillation?
Population
521 apixaban-treated and 1561 untreated maintenance dialysis patients with incident nonvalvular AF
Comparison
Apixaban vs no anticoagulation
Design
Retrospective propensity score-matched cohort study
Authors
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Apixaban was associated with higher bleeding without lower thromboembolism in dialysis AF; leaves open need for RCTs before any practice change.
Cohort (n=2,082)
Yes
Does apixaban reduce hospital admission for a new stroke, transient ischemic attack, or systemic thromboembolism in patients on maintenance dialysis with incident nonvalvular atrial fibrillation?
p-value: p==0.004
In patients on maintenance dialysis with incident nonvalvular atrial fibrillation, apixaban did not reduce thromboembolic events but increased the risk of fatal or intracranial bleeding, particularly at the standard 5 mg twice daily dose.
Mavrakanas et al. (2020) conducted a cohort in maintenance dialysis with incident, nonvalvular atrial fibrillation (n=2,082). apixaban vs. no anticoagulation was evaluated on hospital admission for a new stroke (ischemic or hemorrhagic), transient ischemic attack, or systemic thromboembolism (p==0.004). Apixaban compared with no anticoagulation in dialysis patients with atrial fibrillation did not reduce stroke or systemic thromboembolism but was associated with higher fatal or intracranial bleeding.
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