Early AF management in patients with kidney failure better with apixaban vs warfarin

In patients with kidney failure who are undergoing haemodialysis, initiating treatment with apixaban soon after a diagnosis of atrial fibrillation (AF) is associated with lower risks of ischaemic stroke and clinically important bleeding compared with warfarin, according to a study.

Researchers performed a target trial emulation using data from the US Renal Data System. They identified oral anticoagulant-naïve patients with kidney failure on haemodialysis who initiated either apixaban (n=3,985) or warfarin (n=6,426) within 30 days of AF diagnosis. Propensity-score matching was conducted to match apixaban initiators with warfarin initiators, yielding 3,978 pairs for inclusion in the analysis.

The primary outcomes were ischaemic stroke and clinically important bleeding. Secondary outcomes included thromboembolic and bleeding events.

At baseline, the median CHA2DS2-VASc score was 4 overall. Apixaban was initiated a median 6 days after AF and used for a median of 58 days, while warfarin was initiated a median 5 days after AF and used for a median of 93 days.

Compared with warfarin, apixaban was associated with a 34-percent lower risk of ischaemic stroke (hazard ratio [HR], 0.66, 95 percent confidence interval [CI], 0.47–0.94; p=0.02) and a 28-percent lower risk of clinically important bleeding (HR, 0.72, 95 percent CI, 0.63–0.83; p<0.001).

All-cause mortality, as well as the negative control outcomes of hip fracture and pneumonia, did not differ between the two treatment groups. Results were consistent in analyses restricted to patients with CHA2DS2-VASc score of ≥2.