Abstract 17197: Contemporary Trends in the Use of Direct Oral Anticoagulants in Dialysis Patients With Atrial Fibrillation in the United States

    loading  Checking for direct PDF access through Ovid

Abstract

Introduction: End-stage renal disease (ESRD) patients on dialysis with atrial fibrillation (AF) are at high risk for both thrombotic complications and treatment-associated bleeding. Although direct oral anticoagulants (DOACs) reduce these risks in other populations, their use in dialysis patients is not well characterized and is discouraged due to a lack of empirical data.

Hypothesis: We sought to characterize the utilization of DOACs in dialysis patients with AF requiring anticoagulation.

Methods: We identified eligible dialysis patients continuously enrolled in the comprehensive US Renal Data System database who were prescribed warfarin or a DOAC (new start or switch from warfarin) from October 2010 (following initial FDA approval) to December 2015. Patients with valvular heart disease were excluded.

Results: From a population of 1,313,637 patients with ESRD, 21,593 dialysis patients (female 48.5%, mean age 65.8 years) with a diagnosis of AF and a prescription for oral anticoagulation were identified. A total of 1,690 (7.8%) patients were prescribed DOACs (apixaban n=1,301, dabigatran n=201, rivaroxaban n=188; new start n=1,467, switch from warfarin=223), whereas 19,903 (92.2%) patients were prescribed warfarin only. DOACs were increasingly utilized relative to warfarin over the study period (p-for-trend <0.001; Figure), rising from 0.16% to 29.16%. Apixaban accounted for the majority of new DOAC prescriptions. Patients on DOACs and warfarin had comparable risk profiles, with similar age (mean 66.1 vs 65.7 years, p=0.23), prevalence of cerebrovascular disease (8.5% vs 9.0%, p=0.44), and CHA2DS2Vasc scores (mean 3.14 vs 3.18, p=0.28).

Conclusions: Overall use of DOACs in dialysis patients with AF is increasing rapidly and exceeded over one-quarter of prescriptions in 2015. This highlights the need for further study of these drugs in this complex population that is typically excluded from clinical trials.

Related Topics

    loading  Loading Related Articles