Direct Oral Anticoagulant Use Increasing in Dialysis Patients With AFib

End-stage renal disease patients on dialysis with atrial fibrillation are at high risk for thrombotic complications.

Data on the contemporary trends of direct oral anticoagulant use among end-stage renal disease (ESRD) patients on dialysis with atrial fibrillation (AF) was presented at the 2017 American Heart Association’s (AHA) Scientific Sessions.

The use of direct oral anticoagulants in lowering the risk of thrombotic complications and treatment-associated bleeding is not well established in patients with ESRD on dialysis. The use of these medications “is discouraged due to a lack of empirical data,” explained lead author Konstantino Siontis. 

To better understand the use of direct oral anticoagulants in this patient population with AF, the study authors analyzed eligible dialysis patients continuously enrolled in the comprehensive U.S. Renal Data System database who were prescribed warfarin or a direct oral anticoagulant (new initiation or switch from warfarin) between October 2010 to December 2015. 

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Of the >1.3 million patients with ESRD, the authors identified 21,593 dialysis patients with AF who had a prescription for oral anticoagulation. The majority of patients (92.2%) were prescribed warfarin only compared to a direct oral anticoagulant (apixaban [n=1,301], dabigatran [n=201], and rivaroxaban [n=188]); most of the patients were newly initiated (n=1,467) vs. having switched from warfarin therapy (n=223). The majority of new direct oral anticoagulant prescriptions were for apixaban.

In general, results showed that the use of direct oral anticoagulants increased relative to warfarin over the study period from 0.16% to 29.16% (P<0.001). 

Risk profiles for patients were similar between warfarin users and direct oral anticoagulant users: mean age (65.7 years vs. 66.1 years; P=0.23), prevalence of cerebrovascular disease (9.0% vs. 8.5%; P=0.44), and CHA2DS2Vasc scores (mean 3.18 vs. 3.14; P=0.28). 

“Overall use of [direct oral anticoagulants] in dialysis patients with AF is increasing rapidly and exceeded over one-quarter of prescriptions in 2015,” the authors concluded. “This highlights the need for further study of these drugs in this complex population that is typically excluded from clinical trials.”

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