Eliquis Could Impact In-Hospital Mortality Rates of Renal Failure Patients with Atrial Fibrillation
In Eliquis, Atrial fibrillation (AFib)
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By: Saparja Nag Apr. 17, 2018
Eliquis, an oral anticoagulant developed by Bristol-Myers Squibb, is targeted at reducing patients’ risk of stroke or systemic embolism in patients with non-valvular atrial fibrillation, in addition to preventing and treating DVT (deep vein thrombosis) and PE (pulmonary embolism) in high-risk patients. The link between atrial fibrillation and conditions of the kidney has been examined in numerous clinical studies but the exact impact of anticoagulants on renal failure patients’ risk of bleeding has yet to be empirically understood in clinical trials.
A study in 2012 underlined the need to test newer oral anticoagulants, i.e. Factor Xa inhibitors such as Eliquis (apixaban), in patient populations with chronic renal failure. In comparison warfarin is a traditional anticoagulant that can further increases risk of bleeding. Apixaban, the active ingredient in Eliquis, shows particular promise as an effective alternative to warfarin for patients with impaired kidney function. 92% of warfarin is eliminated via the kidney, compared to the 27% of apixaban which places less strain on the kidneys. Until specific studies on the effects of Factor Xa inhibitors, like apixaban, in patients with impaired renal function are performed, general clinical guidelines as to when these anticoagulants should be administered to patients can not created yet. Each patient’s risk of stroke and bleeding should be evaluated and compared against the potential benefits of an anticoagulant such as Eliquis to determine whether it is a suitable treatment for renal failure patients with AFib.
One study in 2011 carried out by Dr. Marie T. Brown and Dr. Jennifer K. Bussell determined that approximately 50% of patients do not take prescriptions properly, which may be a significant factor in mortality rates of patients. An earlier study from 2005 from Dr. Lars Osterberg and Dr. Terrence Blaschke also examined how medication adherence can affect a patient’s recovery. They found that low adherence to a prescription regimen leads to more morbidities, higher mortality rate, and costs an estimated $100 billion per year. According to this study, between one-third and two-thirds of all medication-related hospitalizations in the U.S. are due to low rates of medication adherence. These studies indicate that non-adherence among patients can lead to higher mortality rates and higher costs.
For patients with both renal failure and atrial fibrillation who are suitable for Eliquis treatment, medication adherence may be the key to managing their health. The fact that Eliquis is predominantly processed outside of the kidney may decrease risk of additional side effects for renal failure patients. If these patients are experiencing less severe side effects, especially those that would be exacerbated by warfarin, they would be more likely to adhere to their prescription regimen. Based on the studies on medication adherence, renal failure patients consistently taking Eliquis to treat their atrial fibrillation may be able to decrease rates of in-hospital mortality.
In-hospital mortality rates for renal failure patients with and without AFib highlight a significant population that could benefit from Eliquis. These differences in mortality rates, provided from Dexur’s data, for patients with renal failure underline the importance of medication adherence. Dexur analysts studied renal failure patients at three hospitals around the country to determine the mortality rates of such patients who also had atrial fibrillation and those who did not have atrial fibrillation. Three hospitals were studied - Saint Francis Hospital and Medical Center in Hartford, CT, Holmes Regional Medical Center in Melbourne, FL, and Memorial Medical Center in Springfield, IL. Patients in this study were classified under DRG-682, defined as renal failure with major complications, the most severe of the three renal failure diagnosis-related groups. DRG-682 patients at Saint Francis Hospital Medical Center without AFib had a 6% mortality rate, which rose to 10% for patients with AFib. Holmes Regional Medical Center DRG-682 patients had a 5% mortality rate with AFib and a 11% mortality rate for those without AFib. At Memorial Medical Center, renal failure patients with AFib had a mortality rate of 7% and patients without AFib had a mortality rate of 12%. The differences in mortality rates of DRG-682 patients with AFib and patients without AFib for these three hospitals varied between 4% and 6%, which is consistent with respective state and national averages.
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- Total DRG-682 discharge volume, DRG-682 with atrial fibrillation discharge volume, mortality rates with and without atrial fibrillation for Saint Francis Hospital and Medical Center, Holmes Regional Medical Center, and Memorial Medical Center
- Difference in mortality rates with and without atrial fibrillation at Saint Francis Hospital and Medical Center, Holmes Regional Medical Center, and Memorial Medical Center, respective states, and nation
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