SHM Converge Scientific Abstract ePoster Gallery-Comparing the Safety and Effectiveness of Apixaban and Warfarin for Acute Venous Thromboembolism in Patients With End Stage Renal Disease

Comparing the Safety and Effectiveness of Apixaban and Warfarin for Acute Venous Thromboembolism in Patients With End Stage Renal Disease

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This national retrospective cohort study compared apixaban with warfarin for treatment of acute venous thromboembolism (VTE) in patients with end-stage renal disease (ESRD) on dialysis. Using US Renal Data System claims data, the investigators included adults newly started on either anticoagulant between 2014 and 2018 who had a VTE diagnosis close to treatment initiation. Patients with recent anticoagulant use, atrial fibrillation, or hospice enrollment were excluded. Outcomes were assessed over six months.<br /><br />Among 11,565 patients, 2,302 received apixaban and 9,263 received warfarin. Apixaban use rose substantially over time, from 2% of the combined cohort in 2014 to 47% in 2018. The main finding was that apixaban was associated with less bleeding than warfarin. After adjustment with propensity score weighting, apixaban had lower risks of total major bleeding, clinically relevant non-major bleeding, intracranial bleeding, and gastrointestinal bleeding. The risk of fatal major bleeding was also lower or borderline lower.<br /><br />For effectiveness, recurrent VTE rates were similar between groups, though there was a small trend favoring apixaban. All-cause mortality was also similar.<br /><br />Sensitivity analyses supported the bleeding benefit, including analyses of apixaban users taking only 5 mg tablets or only 2.5 mg tablets, both of which showed lower bleeding than warfarin.<br /><br />Overall, the study concluded that in ESRD patients with acute VTE, apixaban appears safer than warfarin with respect to bleeding, while showing similar rates of recurrent VTE and mortality. Limitations included reliance on Medicare fee-for-service claims, lack of inpatient anticoagulant details, and limited generalizability to Medicare Advantage patients.

Asset Subtitle

Michael I. Ellenbogen

Meta Tag

Author List Daniel J. Brotman, Jodi Segal, Michael I. Ellenbogen, Michael Streiff, Shirin Ardeshirrouhanifard, Steven Deitelzweig

Category Research

Concept Apixaban

Concept Warfarin

Concept End-stage Kidney Disease

Concept Acute Venous Thromboembolism

Concept Bleeding

Distinguished Non-Finalist

Presenter Organization Johns Hopkins School of Medicine

Presenting Author Michael I. Ellenbogen

Track Outcomes Research

Keywords

apixaban

warfarin

end-stage renal disease

dialysis

venous thromboembolism

bleeding risk

recurrent VTE

propensity score weighting

intracranial bleeding

gastrointestinal bleeding

Apixaban

Warfarin

End-stage Kidney Disease

Acute Venous Thromboembolism

Bleeding