More research needed on anticoagulation for patients with CKD
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SCOTTSDALE — More research is needed on the value of anticoagulation for patients with late-stage chronic kidney disease with atrial fibrillation who are on dialysis in efforts to prevent stroke, according to a presentation here.
“This is a difficult dilemma – whether we should anticoagulate patients with late-stage CKD and on dialysis to prevent stroke,” Manish M. Sood, MD, MSc, FRCPC, Jindal research chair for the prevention of kidney disease and associate professor of medicine in the school of epidemiology and public health at the University of Ottawa, said. “There are no clear answers.”
Ongoing trials are struggling to produce results, Sood said. The RENal hemodialysis patients ALlocated apixaban versus warfarin in Atrial Fibrillation” (RENAL-AF) randomized patients on Bristol-Myers Squibb’s Eliquis (apixaban 2.5 mg twice daily) or warfarin to see whether apixaban reduced bleeding. The study ended early due to low recruitment, so data from the 154 patients the researchers did evaluate were insufficient, Sood said.
“We’re sitting here waiting for years hoping the answers come. We may not get the answers,” Sood said. “These trials may not pull off [results] in the end, despite everyone’s best efforts, and then we may still be in the exact same place we are 5 years from now.”
The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial tested rivaroxaban at very low doses (2.5 mg and 5 mg) with or without aspirin and included a large number of patients with an eGFR less than 60 mL/min/1.73m2. The study found patients in the rivaroxaban plus aspirin group had a 0.76 reduction in major adverse cardiac events regardless of eGFR.
Encouraged from the findings of the COMPASS trial, an international, multicenter, placebo-controlled randomized, controlled trial for Treatment of CVD with Low Dose Rivaroxaban in Advanced CKD (TRACK) is underway and is putting patients with CKD stage 4 and stage 5 on dialysis on rivaroxaban alone for cardiovascular prevention. Results are expecting in the coming years.
“We’re hoping that this will change the paradigm for how to prevent cardiac disease in some of our advanced CKD patients,” Sood said. – by Erin T. Welsh
Reference:
Sood M. Anticoagulation at the intersection of cardiorenal disease. Presented at The Cardio Renal Metabolic Conference; March 6-7, 2020; Scottsdale.
Disclosure: Sood reports receiving funding from AstraZeneca, Heart and Stroke Foundation of Canada, Kidney Foundation of Canada, Canadian Medical Association and the Ottawa Hospital Innovation Fund.