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. 2022 May;17(5):693-702.
doi: 10.2215/CJN.14021021. Epub 2022 Apr 25.

Apixaban versus Warfarin for Treatment of Venous Thromboembolism in Patients Receiving Long-Term Dialysis

James B Wetmore  1   2 , Charles A Herzog  1   3 , Heng Yan  1 , Jorge L Reyes  4 , Eric D Weinhandl  1   5 , Nicholas S Roetker  1
Affiliations

Apixaban versus Warfarin for Treatment of Venous Thromboembolism in Patients Receiving Long-Term Dialysis

James B Wetmore et al. Clin J Am Soc Nephrol. 2022 May.

Abstract

Background and objectives: The association of apixaban compared with warfarin for the treatment of venous thromboembolism in patients receiving maintenance dialysis is not well studied.

Design, setting, participants, & measurements: We conducted a retrospective cohort study of Medicare fee-for-service beneficiaries receiving dialysis using United States Renal Data System data from 2013 to 2018. The study included patients who received a new prescription for apixaban or warfarin following a venous thromboembolism diagnosis. The outcomes were recurrent venous thromboembolism, major bleeding, and death. Outcomes were analyzed using Cox proportional hazards regression for intention-to-treat and censored-at-drug-switch-or-discontinuation analyses. Models incorporated inverse probability of treatment and censoring weights to minimize confounding and informative censoring.

Results: In 12,206 individuals, apixaban, compared with warfarin, was associated with lower risks of both recurrent venous thromboembolism (hazard ratio [HR], 0.58; 95% confidence interval [95% CI], 0.43 to 0.77) and major bleeding (HR, 0.78; 95% CI, 0.62 to 0.98) in the intention-to-treat analysis over 6 months of follow-up. However, there was no difference between apixaban and warfarin in terms of risk of all-cause death (HR, 1.04; 95% CI, 0.94 to 1.16). Corresponding hazard ratios for the 6-month censored-at-drug-switch-or-discontinuation analysis and for corresponding analyses limited to a shorter (3-month) follow-up were all highly similar to the primary analysis.

Conclusions: In a large group of US patients on dialysis with recent venous thromboembolism, we observed that apixaban was associated with lower risk of recurrent venous thromboembolism and of major bleeding than warfarin. There was no observed difference in mortality.

Trial registration: ClinicalTrials.gov NCT02664155.

Keywords: ESKD; apixaban; deep vein thrombosis; dialysis; direct oral anticoagulants; end stage kidney disease; warfarin.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Construction of the study cohort. VTE, venous thromboembolism.
Figure 2.
Figure 2.
Comparisons, adjusted using the inverse probability of treatment (IPT) and the inverse probability of censoring (IPC) weighting for sociodemographic factors, comorbid conditions, disability proxy score, concomitant medications, and health care utilization, for apixaban versus warfarin in the 6-month follow-up analysis. CAS, censored-at-drug-switch-or-continuation; 95% CI, 95% confidence interval; HR, hazard ratio; ITT, intention-to-treat; PY, person-years.
Figure 3.
Figure 3.
Results of the stratified analyses. AV, arteriovenous; DVT, deep venous thrombosis; HD, hemodialysis; PE, pulmonary embolism.
See this image and copyright information in PMC

Comment in

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