Abstract Number: PB2090
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Atrial Fibrillation
Background: In patients with atrial fibrillation and end-stage chronic kidney disease, the use of warfarin or direct oral anticoagulants (DOACs) for stroke prevention is controversial. Observational studies have shown a steady increase in the use of apixaban versus warfarin in atrial fibrillation (AF) patients on dialysis, and the American College of Cardiology guidelines state it might be reasonable to prescribe warfarin or apixaban in these patients while dabigatran, rivaroxaban and edoxaban are not recommended. The American College of Chest Physicians state DOACs are contraindicated for treatment of venous thromboembolism (VTE) in patients with severe renal impairment.
Aims: To evaluate if the proportion of patients with end-stage renal disease is increasing among patients prescribed different oral anticoagulants for AF or VTE.
Methods: The Michigan Anticoagulation Quality Improvement Initiative (MAQI2) is an ongoing registry of six anticoagulation clinics in the United Sates. Trained staff abstract a random sample of charts from patients initiating oral anticoagulation. The proportion of patients with end-stage renal disease (CrCl < 15mL/min) within each year was calculated from the beginning of 2015 to end of 2019. Test for trend was done with chi-square and linear regression.
Results: In warfarin patients, the proportion of patients with end-stage renal disease ranged from 2.1-3.4% and increased slightly (P=0.001) over time (table). End-stage renal disease among apixaban patients ranged from 0-0.9%, and there was no trend (P=0.25) for increasing prevalence. Only 2 patients were treated with rivaroxaban and no patients on dabigatran or edoxaban had CrCl < 15mL/min.
Conclusions: End-stage renal failure is uncommon in our six anticoagulation clinics, and we have not observed an increased prevalence in apixaban treated patients. A slight increase over time in warfarin patients may be indirect evidence of its preference over DOACs in patients with advanced kidney disease.
| 2015 | 2016 | 2017 | 2018 | 2019 | p-value | |
| Warfarin patients | 3702 | 3732 | 3364 | 3204 | 2989 | — |
| CrCl≤15 mL/min, N (%) | 76 (2.1) | 79 (2.1) | 88 (2.6) | 103 (3.2) | 100 (3.4) | 0.001 |
| Apixaban patients | 30 | 766 | 1032 | 1104 | 1396 | — |
| CrCl≤15 mL/min, N (%) | 0 | 7 (0.9) | 3 (0.3) | 8 (0.7) | 12 (0.9) | 0.25 |
| Rivaroxaban patients | 8 | 509 | 654 | 588 | 530 | — |
| CrCl≤15 mL/min, N (%) | 0 | 1 (0.2) | 0 | 0 | 1 (0.2) | — |
[Prevalence of End-Stage Renal Disease ]
To cite this abstract in AMA style:
Kaatz S, Haymart B, Kong X, Ali M, Kline-Rogers E, Kozlowski J, Krol G, Shah V, Barnes GD, Froehlich JB. Trends in Direct Oral Anticoagulant Use in Renal Failure [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/trends-in-direct-oral-anticoagulant-use-in-renal-failure/. Accessed October 1, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/trends-in-direct-oral-anticoagulant-use-in-renal-failure/