Comparison of Low and Full Dose Apixaban Versus Warfarin in Patients With Atrial Fibrillation and Renal Dysfunction (from a National Registry)
Section snippets
Methods
This is a multicenter prospective cohort study where consecutive eligible patients with NVAF and renal impairment were registered between March 2014 and August 2017 in ten medical centers across Israel. Inclusion criteria were recent apixaban or warfarin prescription (within 3 months), according to treating physician discretion, renal impairment defined as eGFR MDRD below 60 ml/min/BSA, and signing a consent form. Patients were excluded if they had valvular atrial fibrillation or presence of
Results
A total of 2,232 patients were enrolled at 10 Israeli sites from November 2015 to August 2017. The current analysis includes 2,140 patients with full data who have completed the follow-up. The warfarin group included 976 (45.6%) patients, whereas the apixaban group included 1164 (54.4%) patients (5 mg [high dose] 491 and 2.5 mg [low dose] 673).
Table 1 provides the patient's characteristics and outcomes according to the 3 treatment regimens. The apixaban groups' subjects had high mean
Discussion
In this multicenter prospective cohort study we have compared between patients with NVAF and renal dysfunction treated by warfarin with those treated by high or low dose apixaban.
This study revealed several findings:
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Overall, the high dose apixaban group had a better prognosis than the low dose apixaban group and the warfarin group.
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In propensity score analysis demonstrated the appropriately low dose apixaban group had a trend towards better outcomes than the warfarin group.
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Appropriately dosed
Disclosures
Ilan Goldenberg reports financial support was provided by Pfizer Inc. Ilan Goldenberg reports a relationship with Pfizer Inc that includes: funding grants.
Alon Barsheshet and Robert Klempfner have received speaker honoraria from Boehringer Ingelheim, Pfizer, and Bayer.
References (20)
- et al.
Renal impairment and ischemic stroke risk assessment in patients with atrial fibrillation: the loire valley atrial fibrillation project
J Am Coll Cardiol
(2013) - et al.
Inflammation, not hyperhomocysteinemia, is related to oxidative stress and hemostatic and endothelial dysfunction in uremia
Kidney Int
(2001) - et al.
Systemic anticoagulation considerations in chronic kidney disease
Adv Chronic Kidney Dis
(2010) - et al.
Bleeding and thrombotic complications of kidney disease
Blood Rev
(2011) - et al.
Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients
J Thromb Haemostasis
(2005) - et al.
Dose reduction of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a Danish nationwide cohort study
Thromb Res
(2019) - et al.
Non-Vitamin K antagonist oral anticoagulant dosing in patients with atrial fibrillation and renal dysfunction
J Am Coll Cardiol
(2017) - et al.
"R" for "renal" and for "risk": refining risk stratification for stroke in atrial fibrillation
Circulation
(2013) - et al.
Stroke and bleeding in atrial fibrillation with chronic kidney disease
N Engl J Med
(2012) - et al.
Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial
Eur Heart J
(2012)
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These authors contributed equally to this work.