Apixaban May Be Safer Option for Dialysis Patients With Calciphylaxis

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In a small study, apixaban showed promise as an alternative to warfarin in dialysis patients with calciphylaxis who require anticoagulation therapy.
In a small study, apixaban showed promise as an alternative to warfarin in dialysis patients with calciphylaxis who require anticoagulation therapy.

Apixaban, an anticoagulant used to treat venous thromboembolic events, may be a safe and effective alternative to warfarin in patients with end-stage renal disease (ESRD) on dialysis who have calciphylaxis, investigators reported.

Retrospective studies have identified warfarin use as a risk factor for calciphylaxis.

No prospective randomized trials have evaluated the use of apixaban in patients with ESRD on dialysis.

Anna C. Garza-Mayers, MD, and colleagues at Massachusetts General Hospital in Boston, studied 20 patients (11 women, 9 men, mean age 62.4 years) with ESRD on dialysis with calciphylaxis who were treated with apixaban for atrial fibrillation (17 patients) or deep vein thrombosis (3 patients). No cases of thrombosis were reported, according to study findings presented in a paper published in the American Journal of Nephrology. Three patients experienced bleeding and required a transfusion, and anticoagulation was resumed without any further events.

“The data presented here highlight the potential utility of apixaban as oral anticoagulation in patients with ESRD on dialysis and calciphylaxis,” the authors concluded.

Calciphylaxis recurred in 10 of the 20 patients. Of these 10 patients, 8 had calciphylaxis prior to the study, at which time warfarin was not discontinued. Two patients had a recurrence of calciphylaxis within 3 months of warfarin discontinuation.

“Given the increased risk of recurrence of calciphylaxis observed in this study in patients who were continued on warfarin therapy,” the authors concluded, “it is necessary that we investigate non-warfarin anticoagulation options in this patient population.”

Clinical evaluation documented improvement in calciphylaxis in 18 patients. At 1 year after calciphylaxis diagnosis, 4 patients (20%) had died.

Reference

Garza-Mayers AC, Shah R, Sykes DB, et al. The successful use of apixaban in dialysis patients with calciphylaxis who require anticoagulation: A retrospective analysis. Am J Nephrol. 2018;48:168-171.

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