Ionescu Filip, Cooper Christopher, Petrescu Ioana, George Julie, Mansuri Saima
Department of Internal Medicine, Beaumont Health System, Royal Oak, OUWB School of Medicine, Royal Oak, MI, USA.
OUWB School of Medicine, Rochester, MI, USA.
Eur J Haematol. 2021 May;106(5):689-696. doi: 10.1111/ejh.13599. Epub 2021 Mar 8.
Data on the safety of apixaban compared to warfarin in hemodialysis (HD) patients are accumulating, but the impact of concomitant antiplatelet use is unknown.
Compare hemorrhagic risk and impact of antiplatelets in HD patients receiving oral anticoagulants (OAC).
Retrospective, multi-center study of HD patients started on OAC inpatient over 5 years.
707 patients were included: 563 received warfarin, and 144 received apixaban. 197 had bleeding, most in the warfarin group (173 [30.1%] vs 24 [16.7%] in the apixaban group), P-value < .01). However, with concomitant antiplatelet use, frequencies were similar (31.4% vs 25.0%; P-value = .292). Cumulative incidence using bleeding as event of interest and death as competing risk showed higher rates of bleeding with warfarin. In a multivariate model, apixaban was associated with a lower hemorrhagic risk (hazard ratio [HR] 0.55 [95% confidence interval {CI} 0.35-0.86}). Apixaban showed lower hemorrhagic risk alone (HR 0.24, 95% CI 0.10-0.55) and similar risk when administered with antiplatelets (HR 0.93, 95% CI 0.55-1.56).
Apixaban is associated with less bleeding in HD patients compared to warfarin, but concomitant antiplatelet use may negate the safety advantage. Prospective trials are warranted to determine the impact of antiplatelets on apixaban safety.
与华法林相比，阿哌沙班在血液透析（HD）患者中的安全性数据不断积累，但联合使用抗血小板药物的影响尚不清楚。
比较接受口服抗凝剂（OAC）的HD患者的出血风险及抗血小板药物的影响。
对5年内在住院期间开始使用OAC的HD患者进行回顾性多中心研究。
纳入707例患者：563例接受华法林治疗，144例接受阿哌沙班治疗。197例发生出血，多数在华法林组（173例[30.1%]，阿哌沙班组24例[16.7%]），P值<0.01）。然而，联合使用抗血小板药物时，出血频率相似（31.4%对25.0%；P值=0.292）。以出血为感兴趣事件、死亡为竞争风险的累积发病率显示，华法林导致的出血率更高。在多变量模型中，阿哌沙班与较低的出血风险相关（风险比[HR]0.55[95%置信区间{CI}0.35 - 0.86}）。阿哌沙班单独使用时出血风险较低（HR 0.24，95%CI 0.10 - 0.55），与抗血小板药物联合使用时风险相似（HR 0.93，95%CI 0.55 - 1.56）。
与华法林相比，阿哌沙班在HD患者中导致的出血较少，但联合使用抗血小板药物可能会抵消其安全性优势。有必要进行前瞻性试验以确定抗血小板药物对阿哌沙班安全性的影响。
