A specific drug is the best to prescribe to people with both an irregular heartbeat and kidney failure. This population of people is at a particularly high risk of blood clots and stroke, making a safe blood-thinning treatment – a lot of the times – the difference between life and death.
Researchers from the University of Michigan conducted a study to produce the first data to show that a drug called apixaban is safer than warfarin for the population of people with both atrial fibrillation (AF) and kidney failure. Blood-thinning drugs are routinely prescribed to treat AF, a condition characterized by an irregular heartbeat. AF is the most common type of heart arrhythmia, and it increases the risk of stroke, as blood is not pumped effectively out of the heart and to tissues all over the body.
Blood-thinning drugs like warfarin reduce the risk of blood clots, lowering the chances of a stroke, but for people with both AF and kidney failure (requiring dialysis), choosing the right blood-thinning drug can be a challenge for the physician.
When prescribing blood-thinning drugs for AF and kidney failure patients undergoing regular dialysis, physicians have to factor in that dialysis patients are almost always excluded from clinical trials conducted for the sole purpose of testing how effective and safe new treatments are. Plus, blood-thinning drugs like warfarin run the risk of major bleeding even for people without kidney failure.
Dialysis filters the blood in place of the kidneys: removing waste, salt, and extra water to prevent buildup, regulating levels of certain chemicals (potassium, sodium, bicarbonate), and helping control blood pressure.
"Patients on dialysis are one of the most challenging populations, because they have many comorbid conditions, are often on many prescription drugs and are at significant risk of kidney failure associated and treatment-related adverse events," explained senior co-author Rajiv Saran, MD. "Dialysis patients were excluded from all randomized trials that established the utility of the newer anticoagulants.”
The drug that has proved to be the best for people with both AF and kidney failure is apixaban (AKA Eliquis), an anticoagulant (blood thinner). "We found patients on apixaban had a significantly lower risk of major bleeding [30 percent less than warfarin] with no difference in stroke, which is what we try to prevent by prescribing these anticoagulants,” explained first author Konstantinos Siontis, MD.
Apixaban was first approved by the U.S. Food and Drug Administration (FDA) in 2013 to lower the risk of stroke and systemic embolism (blood clots) for people with AF. Researchers conducted their data analysis using information from more than 25,000 Medicare beneficiaries.
It’s important for the population of people with both AF and kidney failure to have access to a safe blood-thinning treatment.
"Atrial fibrillation is a pretty significant determinant of adverse outcomes in this population," Siontis says. "It's a common problem in dialysis patients who generally have a lot of comorbidities. And the patients on dialysis who have Afib experience higher rates of stroke compared to patients with Afib who aren't on dialysis."
The present study was published in the journal Circulation.
Sources: National Kidney Foundation, Bristol-Myers Squibb, Michigan Medicine – University of Michigan
