Abstract: SA-PO859
Prescribing Patterns of Anticoagulants in Dialysis Patients with Incident Atrial Fibrillation in the United States Between 2012 and 2014
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Garlo, Katherine, Brigham and Women's Hospital , Boston , Massachusetts, United States
- Mavrakanas, Thomas, Brigham and Women's Hospital , Boston , Massachusetts, United States
- Neville, Bridget A., Brigham and Women''s Hospital, Boston, Massachusetts, United States
- Charytan, David M., Brigham and Women's Hospital/Harvard Medical School , Brookline, Massachusetts, United States
Background
Four direct acting oral anticoagulants are approved for stroke prevention in atrial fibrillation (AF) and offer advantages over warfarin. However, individuals with advanced kidney disease and dialysis were excluded from phase 3 trials and all agents are excreted by the kidney. Understanding longitudinal prescribing patterns of anticoagulation in dialysis patients is especially important as these agents become integrated into clinical care.
Methods
We used United States Data Renal System (USRDS) data to identify prevalent and incident dialysis patients with new onset atrial fibrillation occurring between Jan 1, 2012-December 31, 2014. Trends in use of apixaban, rivaroxaban, warfarin, or no anticoagulation were identified from Part D Medicare records. Subgroup analyses for demographics and comorbidities were also examined.
Results
Among 743,639 patients receiving maintenance dialysis (399,024 prevalent prior to Jan 1, 2012 and 344,615 incident patients from Jan 1, 2012 - Dec 31, 2014),85,032 had a new diagnosis of AF or flutter after Jan 1, 2012. Upon exclusion for non-continuous part A, B, and D Medicare coverage, death within 30 days of AF diagnosis, and or valvular disease, 27,202 individuals were included in the final analysis (25,372 on hemodialysis and 1,830 on peritoneal dialysis). Of these 6,717 (24.7%) were prescribed warfarin, 309 (1.1%) apixaban, 91 (0.3%) rivaroxaban, and 20,085 (73.8%) did not receive anticoagulation.
Conclusion
Results from this large observational study of 27,202 individuals on dialysis in the United States with AFshow that the majority did not receive anticoagulation (73.8%) between 2012-2014. Warfarin remains the most frequently prescribed anti-coagulant (24.7%). Use of direct acting oral anti-coagulants remains infrequent with the majority receiving apixaban.
Funding
- Private Foundation Support