Kidney Week

Abstract: FR-PO440

Comparative Safety and Effectiveness of Heparin vs. Direct Oral Anticoagulants in Patients with Cirrhosis and ESKD

Session Information

• Hemodialysis Epidemiology and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Lohana, Abhi, Camden Clark Medical Center, Parkersburg, West Virginia, United States

Abhi Lohana, MD

• Akbar, Usman, Camden Clark Medical Center, Parkersburg, West Virginia, United States

Usman Akbar, MD

• Muhibullah, Fnu, Camden Clark Medical Center, Parkersburg, West Virginia, United States

Fnu Muhibullah, MD

• Shafique, Nouman, Nishtar Medical College and Hospital, Multan, Punjab, Pakistan

Nouman Shafique, MBBS

• Shah, Syed Adil Mir, Dow Medical College, Karachi, Pakistan

Syed Adil Mir Shah, MD, MBBS

• Muddana, Neeharika, Camden Clark Medical Center, Parkersburg, West Virginia, United States

Neeharika Muddana, MD

Background

Anticoagulation therapy in patients with cirrhosis and end-stage renal disease (ESRD) presents unique challenges due to the increased risk of both thromboembolic and bleeding events. This study aims to compare the clinical outcomes of patients treated with Heparin versus direct oral anticoagulants (DOACs) in this high-risk patients. Understanding the safety and effectiveness of these treatments in cirrhosis with ESRD is crucial for optimizing patient care and minimizing adverse events.

Methods

We utilized the US collaborative network platform to perform a comparative outcomes analysis on two cohorts: 7333 patients treated with Heparin and 7323 patients treated with DOACs. Propensity score matching was used to balance the cohorts based on demographic and clinical characteristics. Outcomes measured included mortality, stroke, deep vein thrombosis/pulmonary embolism (DVT/PE), acute myocardial infarction (AMI), and major bleeding after 1 year, with risk differences and p-values calculated to assess statistical significance.

Results

The analysis revealed that the Heparin cohort had a significantly higher risk of mortality (risk difference 0.035, p-value 0.000) and major bleeding (risk difference 0.021, p-value 0.005) compared to the DOACs cohort. Conversely, the DOACs cohort exhibited a higher risk of DVT/PE (risk difference -0.025, p-value 0.000). No significant differences were observed between the cohorts for stroke (risk difference -0.001, p-value 0.801) and AMI (risk difference 0.006, p-value 0.204).

Conclusion

This comparative analysis highlights that Heparin is associated with higher risks of mortality and major bleeding, whereas DOACs are associated with a higher risk of DVT/PE. These findings suggest that DOACs may be a safer alternative to Heparin for certain outcomes, although individual patient factors and clinical judgement should guide treatment decisions. Further research is needed to confirm these findings and optimize anticoagulation therapy.

1-year outcomes of patients being treated with heparin and Direct oral anticoagulants (DOACs) in patients with ESRD and cirrhosis.