Apixaban Dosing Patterns Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation Receiving Dialysis: A Retrospective Cohort Study
Abstract
BACKGROUND & OBJECTIVES
Comparison of clinical outcomes across anticoagulation regimens using different apixaban dosing or warfarin is not well-defined in patients with nonvalvular atrial fibrillation (AF) who are receiving dialysis. This study sought to compare these outcomes in a US national cohort of patients with kidney failure receiving maintenance dialysis.
STUDY DESIGN
Retrospective cohort study.
SETTING AND PARTICIPANTS
Patients receiving dialysis represented in the USRDS database 2013-2018 who had AF and were treated with apixaban or warfarin.
EXPOSURE
First prescribed treatment with Apixaban dosed according to the label, apixaban dosed below the label, or warfarin.
OUTCOMES
Ischemic stroke/systemic embolism (SE), major bleeding, and all-cause mortality.
ANALYTICAL APPROACH
Cox proportional hazards models with inverse probability of treatment weighting. Analyses simulating an intention-to-treat (ITT) approach as well as those incorporating censoring at drug switch or discontinuation (CAS) were also implemented. Inverse probability of censoring weighting was used to account for possible informative censoring.
RESULTS
Among 17,156 individuals, there was no difference in risk of stroke/SE among the label-concordant apixaban, below-label apixaban, and warfarin treatment groups. Both label-concordant (HR 0.67, 95% CI 0.55-0.81) and below-label (HR 0.68, 0.55-0.84) apixaban dosing were associated with a lower risk of major bleeding compared to warfarin in ITT analyses.…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 17,156 participants or records.
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