{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:47:07Z","timestamp":1792802827814,"version":"4.5.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["17MCPRP33661217"],"award-info":[{"award-number":["17MCPRP33661217"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Geneva, Faculty of Medicine","id":[{"id":"https:\/\/ror.org\/01swzsf04","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>The relative efficacy and safety of apixaban compared with no anticoagulation have not been studied in patients on maintenance dialysis with atrial fibrillation. We aimed to determine whether apixaban is associated with better clinical outcomes compared with no anticoagulation in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>This retrospective cohort study used 2012\u20132015 US Renal Data System data. Patients on maintenance dialysis with incident, nonvalvular atrial fibrillation treated with apixaban (521 patients) were matched for relevant baseline characteristics with patients not treated with any anticoagulant agent (1561 patients) using a propensity score. The primary outcome was hospital admission for a new stroke (ischemic or hemorrhagic), transient ischemic attack, or systemic thromboembolism. The secondary outcome was fatal or intracranial bleeding. Competing risk survival models were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with no anticoagulation, apixaban was not associated with lower incidence of the primary outcome: hazard ratio, 1.24; 95% confidence interval, 0.69 to 2.23;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.47. A significantly higher incidence of fatal or intracranial bleeding was observed with apixaban compared with no treatment: hazard ratio, 2.74; 95% confidence interval, 1.37 to 5.47;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004. A trend toward fewer ischemic but more hemorrhagic strokes was seen with apixaban compared with no treatment. No significant difference in the composite outcome of myocardial infarction or ischemic stroke was seen with apixaban compared with no treatment. Compared with no anticoagulation, a significantly higher rate of the primary outcome and a significantly higher incidence of fatal or intracranial bleeding and of hemorrhagic stroke were seen in the subgroup of patients treated with the standard apixaban dose (5 mg twice daily) but not in patients who received the reduced apixaban dose (2.5 mg twice daily).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with kidney failure and nonvalvular atrial fibrillation, treatment with apixaban was not associated with a lower incidence of new stroke, transient ischemic attack, or systemic thromboembolism but was associated with a higher incidence of fatal or intracranial bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Podcast<\/jats:title>\n                    <jats:p>This article contains a podcast at https:\/\/www.asn-online.org\/media\/podcast\/CJASN\/2020_05_29_CJN11650919.mp3<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.11650919","type":"journal-article","created":{"date-parts":[[2020,5,22]],"date-time":"2020-05-22T14:29:48Z","timestamp":1590157788000},"page":"1146-1154","source":"Crossref","is-referenced-by-count":98,"title":["Apixaban versus No Anticoagulation in Patients Undergoing Long-Term Dialysis with Incident Atrial Fibrillation"],"prefix":"10.2215","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct02942407","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02933697","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03987711","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3368-247X","authenticated-orcid":false,"given":"Thomas A.","family":"Mavrakanas","sequence":"first","affiliation":[{"name":"Renal Division, Brigham & Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Garlo","sequence":"additional","affiliation":[{"name":"Renal Division, Brigham & Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Charytan","sequence":"additional","affiliation":[{"name":"Nephrology Division, New York University Langone Medical Center and Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,5,22]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.kint.2017.11.019","article-title":"Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle","volume":"93","author":"Roy-Chaudhury","year":"2018","journal-title":"Kidney Int"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1378\/chest.15-1719","article-title":"Stroke, major bleeding, and mortality outcomes in warfarin users with atrial fibrillation and chronic kidney disease: A meta-analysis of observational studies","volume":"149","author":"Dahal","year":"2016","journal-title":"Chest"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1161\/CIRCULATIONAHA.114.014113","article-title":"Dabigatran and rivaroxaban use in atrial fibrillation patients on hemodialysis","volume":"131","author":"Chan","year":"2015","journal-title":"Circulation"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"2888","DOI":"10.1016\/j.jacc.2016.02.082","article-title":"Nonvitamin K anticoagulant agents in patients with advanced chronic kidney disease or on dialysis with AF","volume":"67","author":"Chan","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1681\/ASN.2016090980","article-title":"Apixaban pharmacokinetics at steady state in hemodialysis patients","volume":"28","author":"Mavrakanas","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1161\/CIRCULATIONAHA.118.035418","article-title":"Outcomes associated with apixaban use in patients with end-stage kidney disease and atrial fibrillation in the United States [published correction appears in Circulation 138: e425, 2018]","volume":"138","author":"Siontis","year":"2018","journal-title":"Circulation"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1053\/j.ajkd.2015.05.019","article-title":"Outcomes after warfarin initiation in a cohort of hemodialysis patients with newly diagnosed atrial fibrillation","volume":"66","author":"Shen","year":"2015","journal-title":"Am J Kidney Dis"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"e008643","DOI":"10.1161\/JAHA.118.008643","article-title":"Effectiveness and safety of apixaban, dabigatran, and rivaroxaban versus warfarin in frail patients with nonvalvular atrial fibrillation","volume":"7","author":"Martinez","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"395","DOI":"10.4140\/TCP.n.2015.395","article-title":"Modified HAS-BLED score and risk of major bleeding in patients receiving dabigatran and rivaroxaban: A retrospective, case-control study","volume":"30","author":"Tsu","year":"2015","journal-title":"Consult Pharm"},{"key":"B11-20230813","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0895-4356(00)00321-8","article-title":"Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: A matched analysis using propensity scores","volume":"54","author":"Normand","year":"2001","journal-title":"J Clin Epidemiol"},{"key":"B12-20230813","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk","volume":"94","author":"Fine","year":"1999","journal-title":"J Am Stat Assoc"},{"key":"B13-20230813","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1093\/aje\/kwi307","article-title":"Survival bias associated with time-to-treatment initiation in drug effectiveness evaluation: A comparison of methods","volume":"162","author":"Zhou","year":"2005","journal-title":"Am J Epidemiol"},{"key":"B14-20230813","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1161\/CIRCULATIONAHA.113.004777","article-title":"Warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis","volume":"129","author":"Shah","year":"2014","journal-title":"Circulation"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1681\/ASN.2009030319","article-title":"Warfarin use associates with increased risk for stroke in hemodialysis patients with atrial fibrillation","volume":"20","author":"Chan","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1038\/ki.2009.477","article-title":"Atrial fibrillation in hemodialysis patients: Clinical features and associations with anticoagulant therapy","volume":"77","author":"Wizemann","year":"2010","journal-title":"Kidney Int"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"2662","DOI":"10.2215\/CJN.04550511","article-title":"Effectiveness and safety of warfarin initiation in older hemodialysis patients with incident atrial fibrillation","volume":"6","author":"Winkelmayer","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"2877","DOI":"10.1161\/CIRCULATIONAHA.108.832139","article-title":"Apixaban, an oral, direct, selective factor Xa inhibitor, in combination with antiplatelet therapy after acute coronary syndrome: Results of the Apixaban for Prevention of Acute Ischemic and Safety Events (APPRAISE) trial","volume":"119","author":"Alexander","year":"2009","journal-title":"Circulation"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/S0140-6736(17)32458-3","article-title":"Rivaroxaban with or without aspirin in patients with stable coronary artery disease: An international, randomised, double-blind, placebo-controlled trial","volume":"391","author":"Connolly","year":"2018","journal-title":"Lancet"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1161\/CIRCOUTCOMES.113.000371","article-title":"Validity of international classification of disease codes to identify ischemic stroke and intracranial hemorrhage among individuals with associated diagnosis of atrial fibrillation","volume":"8","author":"Thigpen","year":"2015","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"B21-20230813","doi-asserted-by":"crossref","first-page":"2054358119878719","DOI":"10.1177\/2054358119878719","article-title":"The association of atrial fibrillation and ischemic stroke in patients on hemodialysis: A competing risk analysis","volume":"6","author":"Findlay","year":"2019","journal-title":"Can J Kidney Health Dis"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.11650919","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:39:50Z","timestamp":1786369190000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.11650919"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,22]]},"references-count":20,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.11650919","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,22]]}}}