Patients with ESRD (end-stage renal disease) are usually prescribed coumadin when they need anticoagulation; the reason being that we know very little (or not at all) about the effect of new oral anticoagulants in patients with ESRD.
In this study, Siontis et al performed a retrospective cohort study of Medicare beneficiaries with ESRD and atrial fibrillation, the later an indication for anticoagulation. Outcomes were compared between patients who were treated with apixaban versus patients who were treated with warfarin. Authors examined the survival difference between the two groups for stroke or systemic embolism, major bleeding, gastrointestinal bleeding, intracranial bleeding, and death using Kaplan–Meier analyses and hazard ratios (HRs) and 95% CIs were obtained using Cox regression analyses.
Authors found that there was no difference in stroke and systemic embolism between the two groups. However, the group taking apixaban had 28% lower risk of major bleed.
While this is retrospective data, and clinical trial data is lacking, this study will support the use of new oral anticoagulants in ESRD patients.
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