ANTICOAGULATION USE IN PERITONEAL DIALYSIS PATIENTS WITHIN THE WESTERN RENAL SERVICE
Dr Sumedh Jayanti1,2, Dr Mirna Vucak-Dzumhur1
1Department of Renal Medicine, Westmead Hospital, Sydney, Australia, 2University of Sydney, Sydney, Australia
Aim: This study aimed to evaluate current anticoagulation patterns and associated complications among peritoneal dialysis (PD) patients within the Western Renal Service (WRS).
Background: Warfarin remains the predominant oral anticoagulant in PD patients, despite known risks like calciphylaxis. Apixaban, with potential benefits, remains under-explored in PD, despite increasing use in haemodialysis. Identifying an optimal anticoagulant is critical, especially with the prevalence of atrial fibrillation (AF) in dialysis patients being as high as 25%.
Methods: A cross-sectional analysis was conducted within the WRS (Western Sydney and Nepean Blue Mountain local health districts), reviewing anticoagulation usage and bleeding incidents over the past five years.
Results: As of February 1st, 2024, 319 PD patients were identified. 27 patients used warfarin, for which the indications (number) include: AF (20), pulmonary emboli (3), deep-venous thrombosis (2), anti-phospholipid syndrome (1), left ventricular thrombus (1). 11 patients used apixaban at 2.5mg twice daily, all for AF. Mean age of patients using warfarin was 65.2 +/- 7.5 years and 76.9 +/- 6.1 years for those on apixaban.
Five patients on warfarin had bleeding complications (18.5%) [2 had gastro-intestinal bleeding needing intervention, 1 had an intracranial haemorrhage, 2 had gastro-intestinal haemorrhage not needing intervention]. Two patients on apixaban had bleeding complications (18.2%) [1 had gastro-intestinal bleeding needing intervention, 1 had skin haematomas not needing intervention]. Four of the patients taking warfarin also had significant difficulty with maintaining a therapeutic International Normalised Ratio.
Conclusions: This cross-sectional analysis suggests that apixaban use in PD patients with AF does not increase bleeding rates compared to warfarin, consistent with recent meta-analyses. However, randomised trials are needed to validate broader adoption of apixaban in PD patient care.
Biography:
Sumedh is a first year renal advanced trainee at the Western Renal Service, currently working at Westmead hospital.