The Successful Use of Apixaban in Dialysis Patients with Calciphylaxis Who Require Anticoagulation: A Retrospective
Anna C Garza-Mayers1,2, Radhika Shah1, David B Sykes3,2
1Department of Dermatology, Boston, Massachusetts, USA.
Insights
Apixaban appears safe for patients with calciphylaxis and end-stage renal disease (ESRD) on dialysis, offering an alternative to warfarin. This study found no thrombosis events and manageable bleeding in ESRD patients with calciphylaxis treated with apixaban.
Area of Science:
- Nephrology
- Vascular Medicine
- Dermatology
Background:
- Calciphylaxis is a severe condition causing skin necrosis due to dermal arteriolar calcification.
- It frequently affects patients with end-stage renal disease (ESRD) on hemodialysis, carrying high mortality risks.
- Warfarin is a known risk factor for calciphylaxis.
Purpose of the Study:
- To evaluate the safety and efficacy of apixaban in patients with ESRD on dialysis diagnosed with calciphylaxis.
- To assess apixaban as a potential alternative to warfarin in this high-risk population.
Main Methods:
- Retrospective review of 20 patients with ESRD on dialysis and calciphylaxis.
- Patients were treated with apixaban for deep vein thrombosis or atrial fibrillation.
- Outcomes included thrombosis and bleeding events.
Main Results:
- No thrombotic events were reported in patients treated with apixaban.
- Three patients experienced bleeding requiring transfusion, with successful resumption of anticoagulation.
- Apixaban demonstrated a favorable safety profile in this cohort.
Conclusions:
- Apixaban may be a safe and effective anticoagulant option for patients with ESRD on dialysis and calciphylaxis.
- These findings suggest apixaban could replace warfarin, mitigating calciphylaxis risk.
- Further prospective studies are warranted to confirm these results.
Abstract:
Calciphylaxis is a disease of dermal arteriolar calcification that results in necrosis. It commonly occurs in individuals with end-stage renal disease (ESRD) on hemodialysis and is associated with a high morbidity and mortality. Warfarin use is an identified risk factor. Twenty patients with ESRD on dialysis with calciphylaxis who were treated with apixaban for indications of deep vein thrombosis or atrial fibrillation were identified. There were no reports of thrombosis. Three individuals experienced bleeding requiring a transfusion, and anticoagulation was resumed without further event. Findings suggest that apixaban may be a safe and effective alternative to warfarin in patients with ESRD on dialysis with calciphylaxis.
Related Concept Videos
02:17Ecological Succession
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:15Dialysis
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:26Requirements for Human Life
Oxygen
Atmospheric air is only about 20 percent oxygen, but that oxygen is a key component of the chemical reactions that keep the body alive, including the reactions that produce ATP. Brain cells are susceptible to a lack of oxygen because they require a...