Safety and Efficacy of Apixaban Versus Warfarin in Peritoneal Dialysis Patients With Non Valvular Atrial Fibrillation

Several well conducted randomized controlled trials have established the superiority or non-inferiority of oral anticoagulants (OACs) compared with vitamin K antagonists to treat non valvular atrial fibrillation (AF) for the prevention of thromboembolic events, as well as their safety profile (less major bleeding events with OACs) in the general population. Atrial fibrillation is associated with higher morbidity and mortality in patients with ESKD but there is a lack of randomized data in ESKD on hemodialysis and no data on peritoneal dialysis. Therefore, available evidence comes from retrospective observational studies that are notoriously unreliable to estimate treatment effects. In the population of patients with end stage renal disease (ESRD) on peritoneal dialysis, the investigators hypothesize that apixaban will be safer and as effective than warfarin for the management of non valvular AF, with a robust methodology: a randomized controlled trial. Individually, if the study hypothesis is confirmed during this protocol, the benefit could be direct in the experimental arm with less bleeding than in standard-of-care arm. Moreover, the risk of bleeding with apixaban will be reduced with the use of concordant dosing in peritoneal dialysis condition, known from APIDP1 study. Collectively, the investigators hope for an improvement in scientific knowledge that will allow us to optimize the treatment of atrial fibrillation in subjects on peritoneal dialysis, maybe with the help of pharmacodynamics indicator.