Department of Hematological Medicine, Guy's & St. Thomas' NHS Foundation Trust, King's College London, London, United Kingdom.
SIMR, LLC, Ann Arbor, Michigan, United States.
Thromb Haemost. 2022 Jun;122(6):926-938. doi: 10.1055/s-0041-1740254. Epub 2021 Dec 28.
There has been limited evidence reported about the outcomes of oral anticoagulants among patients with venous thromboembolism (VTE) and chronic kidney disease (CKD), especially those with stage V/end-stage renal disease (ESRD). This retrospective cohort analysis of five U.S. claims databases evaluated the risk of recurrent VTE, major bleeding (MB), and clinically relevant nonmajor bleeding (CRNMB) for apixaban versus warfarin among VTE patients diagnosed with CKD, including ESRD. Inverse probability treatment weighting (IPTW) was used to balance patient characteristics between treatment cohorts. Hazard ratios (HRs) were calculated for recurrent VTE, MB, and CRNMB among patients with CKD who experienced an index VTE. An interaction analysis was conducted to evaluate treatment effects across different stages of CKD. A total of 29,790 VTE patients with CKD were selected for analyses, of whom 10,669 (35.8%) initiated apixaban and 19,121 (64.2%) initiated warfarin. Among IPTW-balanced patient cohorts, the apixaban group had significantly lower risk of recurrent VTE (HR: 0.78; 95% confidence interval [CI]: 0.66-0.92), MB (HR: 0.76; 95% CI: 0.65-0.88), and CRNMB (HR: 0.86; 95% CI: 0.80-0.93) than the warfarin group. When stratified by CKD stage (stage I/II: 8.2%; stage III: 49.4%; stage IV: 12.8%; stage V/ESRD: 12.0%; stage unspecified: 17.6%), no significant interaction was observed for effects of apixaban versus warfarin on recurrent VTE or MB. In summary, apixaban was associated with a significantly lower risk of recurrent VTE and MB than warfarin among VTE patients with CKD. CKD stages did not have significant impact on treatment effects for recurrent VTE and MB.
关于静脉血栓栓塞症（VTE）和慢性肾脏病（CKD）患者使用口服抗凝剂的结局，已有有限的证据报道，特别是那些处于 V 期/终末期肾病（ESRD）的患者。这项对五个美国索赔数据库的回顾性队列分析评估了阿哌沙班与华法林相比在 VTE 合并 CKD 患者（包括 ESRD）中的复发性 VTE、大出血（MB）和临床相关非大出血（CRNMB）的风险。使用逆概率治疗加权（IPTW）在治疗队列之间平衡患者特征。计算 CKD 患者发生 VTE 指数后复发性 VTE、MB 和 CRNMB 的风险比（HR）。进行交互分析以评估不同 CKD 阶段的治疗效果。共选择了 29790 名 VTE 合并 CKD 的患者进行分析，其中 10669 名（35.8%）患者起始使用阿哌沙班，19121 名（64.2%）患者起始使用华法林。在 IPTW 平衡的患者队列中，阿哌沙班组复发性 VTE（HR：0.78；95%置信区间[CI]：0.66-0.92）、MB（HR：0.76；95% CI：0.65-0.88）和 CRNMB（HR：0.86；95% CI：0.80-0.93）的风险显著低于华法林组。按 CKD 分期分层（I/II 期：8.2%；III 期：49.4%；IV 期：12.8%；V/ESRD 期：12.0%；分期不明：17.6%），阿哌沙班与华法林相比对复发性 VTE 或 MB 的疗效无显著交互作用。总之，与华法林相比，阿哌沙班可显著降低 VTE 合并 CKD 患者的复发性 VTE 和 MB 风险。CKD 分期对复发性 VTE 和 MB 的治疗效果无显著影响。
