Safety and effectiveness of apixaban compared to warfarin in dialysis patients

ESSENTIALS: The safety of apixaban in patients on dialysis is currently debated. Bleeding events were retrospectively compared for dialysis patients on warfarin vs apixaban. Overall bleeding events were significantly less frequent in apixaban group compared to warfarin group. Apixaban appears to be a safe and effective choice for anticoagulation in patients on dialysis. BACKGROUND: The use of apixaban for stroke prophylaxis or for the treatment of venous thromboembolism in end stage renal disease (ESRD) patients maintained on dialysis is based on one single‐dose pharmacokinetic study. There is a deficiency of clinical evidence supporting safety in this population. OBJECTIVE: The purpose of this study was to determine the safety and efficacy of apixaban compared with warfarin in dialysis patients. PATIENTS/METHODS: This is a retrospective cohort study conducted at the University of Virginia Medical Center. A total of 124 ESRD patients maintained on dialysis who either received apixaban (n = 74) or warfarin (n = 50) between January 1, 2014 and October 31, 2016 were included in the study. We used multivariable logistic regression to compare the likelihood of patients experiencing a bleeding event based on anticoagulant therapy. RESULTS: The apixaban group experienced fewer overall bleeding events than the warfarin group (18.9% vs 42.0%; P = .01); this significant difference persisted in adjusted analysis (OR = 0.15; 95% CI = 0.05‐0.46; P = .001). Major bleeding events were less frequent in the apixaban group compared with patients on warfarin (5.4% vs 22.0%; P = .01). There were no recurrent ischemic strokes in either groups. A lower, non‐significant, incidence of recurrent VTE was found in patients on apixaban compared with warfarin (4.4% vs 28.6%; P = .99). CONCLUSION: Compared to warfarin, our findings suggest that apixaban is a safe and effective alternative in patients with ESRD maintained on dialysis, with apixaban patients experiencing fewer bleeding events than warfarin patients.