• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • 2MM Podcast
  • Write for us
  • Contact Us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Cardiology

Direct oral anticoagulants may be the superior treatment for patients with atrial fibrillation on dialysis

byKathleen LauandAlex Chan
March 31, 2021
in Cardiology, Nephrology
Reading Time: 2 mins read
0
Share on FacebookShare on Twitter

1. Direct oral anticoagulants may have a superior risk-benefit profile compared to vitamin K antagonists in atrial fibrillation for patients with hemodialysis.

Evidence Rating Level: 2 (Good)

While direct oral anticoagulants (DOACs) have been shown to have superior risk-benefit profiles over vitamin K antagonists (VKAs) in patients with atrial fibrillation and normal renal function or early stage chronic kidney disease (CKD). This observational follow-up study of the randomized controlled trial, Valkyrie, investigates the comparative efficacy and safety of DOACs versus VKAs for atrial fibrillation in the hemodialysis population. In Valkyrie, 132 patients on chronic hemodialysis were randomized in a 1:1 ratio to receive a VKA with a target INR of 2-3, rivaroxaban 10 mg daily, or rivaroxaban 10mg and vitamin K2 2000 ug thrice weekly post-dialysis for 18 months. Rivaroxaban 10 mg was chosen based on the results of a pharmacokinetic and pharmacodynamic analysis, which showed that this dose provided patients on hemodialysis a similar exposure to a dose of rivaroxaban 20 mg in healthy individuals.  In this open-label, prospective trial, follow-up was extended for at least 18 additional months for patients continuing their originally assigned treatment, to a median follow-up of 1.88 years.For the composite primary endpoint, fewer fatal and nonfatal cardiovascular events occurred in either rivaroxaban arm compared to the VKA arm (rivaroxaban vs VKA: HR 0.41, p=0.0006, rivaroxaban and K2 vs VKA: HR 0.34, p=0.0003). While death from any cause, cardiac death, and stroke risk were not significantly different between treatment arms, symptomatic limb ischemia occurred significantly more frequently in the VKA arm than either of the rivaroxaban arms (VKA 20 patients, rivaroxaban 10 patients, rivaroxaban and K2 9 patients, p=0.02). As well, life-threatening and major bleeding was not significantly different between the VKA and rivaroxaban arms individually, but was significantly less in the pooled rivaroxaban groups compared to the VKA group (HR 0.44, p=0.02). Of note, while patients on hemodialysis typically experience high rates of premature, permanent discontinuation of oral anticoagulation, this study showed a withdrawal rate of only 25%. Considering more than two thirds of patients were already stable on oral anticoagulation at randomization, a lower withdrawal rate may have resulted from selecting patients with higher tolerability of anticoagulation. Nonetheless, these findings support that compared with VKA, rivaroxaban, at a reduced dose, significantly decreased the incidence of fatal and nonfatal cardiovascular events as well as major bleeding events in patients on hemodialysis with atrial fibrillation.

Click to read the study in JASN

Image: PD

©2020 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

RELATED REPORTS

Mazdutide significantly reduces weight in adults with overweight or obesity

Cerebral embolic protection does not decrease stroke incidence in TAVI patients

2 Minute Medicine Rewind July 7, 2025

Tags: atrial fibrillationcardiologynephrology
Previous Post

#VisualAbstract: Semaglutide 2.4 mg once a week decreases bodyweight in overweight or obese patients with type 2 diabetes

Next Post

#VisualAbstract: Increased risk of cutaneous squamous cell carcinomas among patients diagnosed wtih actinic keratosis

RelatedReports

Increasing maternal BMI linked to higher risk of cerebral palsy
Cardiology

Mazdutide significantly reduces weight in adults with overweight or obesity

July 11, 2025
Cerebral protection device effective in patients undergoing transcatheter aortic valve implantation
Cardiology

Cerebral embolic protection does not decrease stroke incidence in TAVI patients

July 8, 2025
Weekly Rewinds

2 Minute Medicine Rewind July 7, 2025

July 10, 2025
Atrial fibrillation-specific management increases days alive and out of hospital
Cardiology

Ablation may reduce stroke risk, death, heart failure hospitalization in patients with atrial fibrillation

July 4, 2025
Next Post
#VisualAbstract: Increased risk of cutaneous squamous cell carcinomas among patients diagnosed wtih actinic keratosis

#VisualAbstract: Increased risk of cutaneous squamous cell carcinomas among patients diagnosed wtih actinic keratosis

Mental health parity law associated with financial protection for children

Adolescent risk behavior screening and interventions infrequently provided in hospital settings

Novel coronavirus identified from patients with pneumonia in Wuhan, China

Azithromycin does not improve clinical outcomes in high-risk patients with suspected COVID-19 in the community setting

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • SGLT2 inhibitors may delay cognitive impairment in elderly patients with heart failure
  • Nerandomilast slows decline in FVC in idiopathic pulmonary fibrosis
  • Mazdutide significantly reduces weight in adults with overweight or obesity
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
No Result
View All Result

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.