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July 9, 2026American Journal of Nephrology

Apixaban shows similar ischemic stroke risk to warfarin in peritoneal dialysis patients with NVAF.

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Why the study?

Evidence comparing apixaban and warfarin in patients with kidney failure receiving peritoneal dialysis is limited.

Does apixaban reduce thromboembolic events and bleeding compared to warfarin in peritoneal dialysis patients with newly diagnosed nonvalvular atrial fibrillation?

Comparison

Apixaban vs warfarin initiated within 30 days after NVAF diagnosis

Design

Retrospective propensity-matched cohort study using the US Renal Data System

Key result

In peritoneal dialysis patients with newly-diagnosed nonvalvular atrial fibrillation, apixaban showed similar risks of ischemic stroke (HR 0.92; 95% CI 0.42-2.01) compared to warfarin.

Authors

MHMingyue HeKEKevin F. EricksonHKHania Kassem

Discussion

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Overview

Comparable outcomes with apixaban and warfarin in PD patients with NVAF; leaves open optimal choice pending randomized trials.

Key Points

  • The aim is to evaluate the safety and effectiveness of apixaban versus warfarin in patients with kidney failure on peritoneal dialysis and newly diagnosed nonvalvular atrial fibrillation.
  • Identified Medicare beneficiaries on peritoneal dialysis with newly diagnosed nonvalvular atrial fibrillation from 2014 to 2019.
  • Included patients who initiated apixaban or warfarin within 30 days after diagnosis, using propensity matching.
  • Estimated hazard ratios for thromboembolic events, bleeding, and mortality with Cox models.
  • Among 6,571 patients, 334 initiated apixaban and 717 warfarin within 30 days.
  • No significant differences were observed for ischemic stroke (HR=0.92; 95%CI, 0.42-2.01) and composite thromboembolic outcomes (HR=0.90; 95%CI, 0.66-1.22).
  • No significant differences in bleeding outcomes, including clinically important bleeding (HR=0.81; 95%CI, 0.62-1.07) and all-cause mortality observed.

Study Design

Type

Cohort (n=6,571)

Multicenter

Yes

Structured PICO

Does apixaban reduce thromboembolic events and bleeding compared to warfarin in peritoneal dialysis patients with newly diagnosed nonvalvular atrial fibrillation?

P
Population
6,571 Medicare beneficiaries on peritoneal dialysis with newly diagnosed nonvalvular atrial fibrillation and no prior oral anticoagulation, initiating apixaban or warfarin.
E
Exposure
Apixaban initiated within 30 days after NVAF diagnosis
C
Comparator
Warfarin initiated within 30 days after NVAF diagnosis
O
Outcome
Ischemic stroke and composite of other thromboembolic outcomes with cardiovascular deathhard clinical

Main Result

Hazard Ratio: 0.92 (95% CI 0.42–2.01)

In peritoneal dialysis patients with newly diagnosed nonvalvular atrial fibrillation, apixaban and warfarin have similar safety and effectiveness profiles, suggesting apixaban is a practical alternative.

Cite This Study

He et al. (2026) conducted a cohort in Nonvalvular atrial fibrillation in peritoneal dialysis patients (n=6,571). Apixaban vs. Warfarin was evaluated on Ischemic stroke (HR 0.92, 95% CI 0.42-2.01). In peritoneal dialysis patients with newly-diagnosed nonvalvular atrial fibrillation, apixaban showed similar risks of ischemic stroke (HR 0.92; 95% CI 0.42-2.01) compared to warfarin.

synapsesocial.com/papers/6a4f3aa62b81a944af574d37https://doi.org/10.1159/000553428
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Safety and Efficacy of Apixaban Use in Peritoneal Dialysis: A Review of the Literature2021 · 8 citations
  2. 2Safety and Efficacy of Apixaban versus warfarin in patients with atrial fibrillation or Venous Thromboembolism and End-Stage renal disease on hemodialysis: A systematic review and meta-analysis2021 · 8 citations
  3. 3Safety and efficacy of apixaban versus warfarin in peritoneal dialysis patients with non-valvular atrial fibrillation: protocol for a prospective, randomised, open-label, blinded endpoint trial (APIDP2)2024 · 7 citations
  4. 4Apixaban versus Warfarin for Treatment of Venous Thromboembolism in Patients Receiving Long-Term Dialysis2022 · 44 citations
  5. 5Meta‐analysis evaluating apixaban in patients with atrial fibrillation and end‐stage renal disease requiring dialysis2024 · 7 citations