Abstract
Background: Anticoagulation in patients with chronic kidney disease is a therapeutic challenge since the medical evidence is scarce and the benefits are debatable since the risk of bleeding in these patients is greater.
Purpose: To describe patients with G4-5 kidney disease who received oral anticoagulant therapy for at least 3 months in the central-eastern subnetwork of Bogotá.
Methodology: Analytical study of patients with G4-5 chronic kidney disease, in a reference hospital between January 2018 and December 2021, in which sociodemographic and clinical variables were analyzed, and a logistic regression was performed on anticoagulants and the frequency of events (hemorrhagic or embolic).
Results: 75 anticoagulated patients diagnosed with G4-5 chronic kidney disease were evaluated. The most commonly used anticoagulant was warfarin (76%), apixaban (16%), and rivaroxaban (8%). Major bleeding occurred with warfarin (8.47%), apixaban (10%), and rivaroxaban (16.6%). There are no significant differences between major bleeding with warfarin (OR: 2.8; 95% CI: 0.46;16.9; p= 0.262), and rivaroxaban (OR: 1.86; 95% CI: 0.18;18.7; p=0.596). Clinically relevant non-major bleeding was 28.9% with warfarin. A thrombotic complication only occurred in one patient who received rivaroxaban.
Conclusions: In patients with G4-5 kidney disease who received warfarin and direct oral anticoagulants, no significant differences were found in terms of the presentation of clinically relevant major and non-major bleeding.
References
- Cuente de Alto Costo [Internet]. Magnitud, tendencia y acceso a los servicios; 2020. Disponible en: https://cuentadealtocosto.org/wp-content/uploads/2021/03/CAC.Co_2021_03_03_Libro_MagnitudyTendencia_Asamblea_2021_v5.pdf
- Wainstein M, Bello AK, Jha V, Harris DCH, Levin A, Gonzalez-Bedat MC, et al. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Latin America. Kidney Int Suppl. 2021;11(2):e35-46. https://doi.org/10.1016/j.kisu.2021.01.005
- Kelly DM, Anders HJ, Bello AK, Choukroun G, Coppo R, Dreyer G, et al. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Western Europe. Kidney Int Suppl. 2021;11(2):e106-18. https://doi.org/10.1016/j.kisu.2021.01.007
- Derebail VK, Rheault MN, Kerlin BA. Role of direct oral anticoagulants in patients with kidney disease. Kidney Int. 2020;97:664-75. https://doi.org/10.1016/j.kint.2019.11.027
- Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2009;361:1139-51. https://doi.org/10.1056/NEJMoa0905561
- Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H, et al. Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism. N Engl J Med. 2009;361:2342-52. https://doi.org/10.1056/NEJMoa0906598
- Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2011;365:981-92. https://doi.org/10.1056/NEJMoa1107039
- Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-91. https://doi.org/10.1056/NEJMoa1009638
- The Einstein Investigators. Oral Rivaroxaban for Symptomatic Venous Thromboembolism. N Engl J Med. 2010;363:2499-510. https://doi.org/10.1056/NEJMoa1007903
- Yaghi S, Shu L, Bakradze E, Salehi Omran S, Giles JA, Amar JY, et al. Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT): A Multicenter International Study. Stroke. 2022;53(3):728-38. https://doi.org/10.1161/STROKEAHA.121.037541
- Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2013;369:2093-104. https://doi.org/10.1056/NEJMoa1310907
- The Hokusai-VTE Investigators. Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism. N Engl J Med. 2013;369:1406-15. https://doi.org/10.1056/NEJMoa1306638
- Wang X, Tirucherai G, Marbury TC, Wang J, Chang M, Zhang D, et al. Pharmacokinetics, pharmacodynamics, and safety of apixaban in subjects with end-stage renal disease on hemodialysis. J Clin Pharmacol. 2016;56(5):628-36. https://doi.org/10.1002/jcph.628
- Mentz RJ, Newby LK, Neely B, Lucas JE, Pokorney SD, Rao MP, et al. Assessment of Administrative Data to Identify Acute Myocardial Infarction in Electronic Health Records. J Am Coll Cardiol. 2016;67(20):2441-2. https://doi.org/10.1016/j.jacc.2016.03.511
- Di Lullo L, Tripepi G, Ronco C, De Pascalis A, Barbera V, Granata A, et al. Safety and effectiveness of rivaroxaban and warfarin in moderate-to-advanced CKD: real world data. J Nephrol. 2018;31:751-6. https://doi.org/10.1007/s40620-018-0501-7
- Reed D, Palkimas S, Hockman R, Abraham S, Le T, Maitland H. Safety and effectiveness of apixaban compared to warfarin in dialysis patients. Res Pract Thromb Haemost. 2018;2(2):291-8. https://doi.org/10.1002/rth2.12083
- Stanton BE, Barasch NS, Tellor KB. Comparison of the Safety and Effectiveness of Apixaban versus Warfarin in Patients with Severe Renal Impairment. Pharmacotherapy. 2017;37(4):412-9. https://doi.org/10.1002/phar.1905
- Siontis KC, Zhang X, Eckard A, Bhave N, Schaubel DE, He K, et al. Outcomes Associated with Apixaban use in Patients with End-Stage Kidney Disease and Atrial Fibrillation in the United States. Circulation. 2018;138(15):1519-29. https://doi.org/10.1161/CIRCULATIONAHA.118.035418
- Reinecke H, Engelbertz C, Bauersachs R, Breithardt G, Echterhoff HH, Gerß J, et al. A Randomized Controlled Trial Comparing Apixaban With the Vitamin K Antagonist Phenprocoumon in Patients on Chronic Hemodialysis: The AXADIA-AFNET 8 Study. Circulation. 2023;147(4):296-309. https://doi.org/10.1161/CIRCULATIONAHA.122.062779
- De Vriese AS, Caluwé R, Van Der Meersch H, De Boeck K, De Bacquer D. Safety and Efficacy of Vitamin K Antagonists versus Rivaroxaban in Hemodialysis Patients with Atrial Fibrillation: A Multicenter Randomized Controlled Trial. J Am Soc Nephrol. 2021;32(6):1474-83. https://doi.org/10.1681/ASN.2020111566
- Bian X, Griffin TP, Zhu X, Islam MN, Conley SM, Eirin A, et al. Senescence marker activin A is increased in human diabetic kidney disease: association with kidney function and potential implications for therapy. BMJ Open Diabetes Res Care. 2019;7:e000720. https://doi.org/10.1136/bmjdrc-2019-000720
- Pokorney SD, Chertow GM, Al-Khalidi HR, Gallup D, Dignacco P, Mussina K, et al. Apixaban for Patients With Atrial Fibrillation on Hemodialysis: A Multicenter Randomized Controlled Trial. Circulation. 2022;146(23):1735-45. https://doi.org/10.1161/CIRCULATIONAHA.121.054990
- Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the Europe. Eur Heart J. 2021;42(5):373-498. https://doi.org/10.1093/eurheartj/ehaa612
- Saenz Morales OA. Anticoagulación en situaciones especiales. Clínica de anticoagulación de la Subred Centro Oriente. 2021:7-16.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.