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Safety of apixaban compared to warfarin in hemodialysis patients: Do antiplatelets make a difference?
Author(s) -
Ionescu Filip,
Cooper Christopher,
Petrescu Ioana,
George Julie,
Mansuri Saima
Publication year - 2021
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13599
Subject(s) - apixaban , medicine , warfarin , hazard ratio , concomitant , hemodialysis , confidence interval , rivaroxaban , atrial fibrillation
Background Data on the safety of apixaban compared to warfarin in hemodialysis (HD) patients are accumulating, but the impact of concomitant antiplatelet use is unknown. Objectives Compare hemorrhagic risk and impact of antiplatelets in HD patients receiving oral anticoagulants (OAC). Methods Retrospective, multi‐center study of HD patients started on OAC inpatient over 5 years. Results 707 patients were included: 563 received warfarin, and 144 received apixaban. 197 had bleeding, most in the warfarin group (173 [30.1%] vs 24 [16.7%] in the apixaban group), P ‐value < .01). However, with concomitant antiplatelet use, frequencies were similar (31.4% vs 25.0%; P ‐value = .292). Cumulative incidence using bleeding as event of interest and death as competing risk showed higher rates of bleeding with warfarin. In a multivariate model, apixaban was associated with a lower hemorrhagic risk (hazard ratio [HR] 0.55 [95% confidence interval {CI} 0.35‐0.86}). Apixaban showed lower hemorrhagic risk alone (HR 0.24, 95% CI 0.10‐0.55) and similar risk when administered with antiplatelets (HR 0.93, 95% CI 0.55‐1.56). Conclusions Apixaban is associated with less bleeding in HD patients compared to warfarin, but concomitant antiplatelet use may negate the safety advantage. Prospective trials are warranted to determine the impact of antiplatelets on apixaban safety.