Arrhythmias & electrophysiology
Effectiveness and safety of apixaban and warfarin in patients with new- onset atrial fibrillation after advanced chronic kidney disease or end-stage kidney disease
Main finding · Cerebral infarctionResult — go to the resultSubdistribution hazard ratio 0.72 95% CI 0.60–0.85Authors' conclusion
This large cohort study highlights the lower risks of cerebrovascular events and bleeding associated with apixaban in patients with stage 5 CKD or those undergoing hemodialysis. However, the optimal dosage of apixaban requires further investigation in future studies.
Study context
- Population
- Patients with chronic atrial fibrillation (AF) after stage 5 chronic kidney disease (CKD) or end-stage kidney disease (ESKD)cases per group after 1:1 propensity score matching (PSM)
- Participants
- 1,364 patients
- Exposure
- Apixaban and warfarin in patients with chronic AF after stage 5 CKD or ESKD
- Apixabann = 1,364
- Warfarinn = 1,364reference
- Outcome
- Cerebral infarction
Methodological detailspropensity score matching (1:1), Cox multivariate analysis, competing-risk adjusted, exclusive users only, TriNetX data (2017-2023)
- Propensity score matching (1:1)
- Cox multivariate analysis
- Competing-risk adjusted
- Exclusive users only
- TriNetX data (2017-2023)
Main finding
As reported in the abstract
Subdistribution hazard ratio
0.72
95% CI 0.60–0.85
Apixaban vs warfarin
SHR 0.72 (95% CI 0.60–0.85)
Observational data: associations, not effects.
Further findings
| Outcome | SHR (95% CI) | |
|---|---|---|
| Hemorrhagic stroke | 0.42 (0.28–0.63) | |
| Cerebrovascular events | 0.69 (0.59–0.81) | |
| All composite outcomes | 0.69 (0.61–0.78) | |
| 0.20.5125Subdistribution hazard ratio (log scale) |
Subgroup analyses (gender, age, dialysis status)
- Consistent improvements across gender, age, and dialysis status
Warfarin's time in therapeutic range
- Warfarin's time in therapeutic range
- 44.4%
Apixaban dose (5-mg vs 2.5-mg) sensitivity analysis
- Lacks sufficient evidence to determine whether the 5-mg or 2.5-mg dose of apixaban is superior
Safety
| Outcome | SHR (95% CI) | |
|---|---|---|
| Gastrointestinal bleeding | 0.77 (0.61–0.97) | |
| Blood transfusion | 0.73 (0.61–0.87) | |
| Bleeding-related outcomes | 0.75 (0.64–0.87) | |
| 0.512Subdistribution hazard ratio (log scale) |
Original publication
Effectiveness and safety of apixaban and warfarin in patients with new- onset atrial fibrillation after advanced chronic kidney disease or end-stage kidney disease. Heart Rhythm. Published 7 February 2025. doi:10.
Summarised from the published abstract; every number is checked against it