Aymeric Couturier: Lessons from the TRACK Trial on Anticoagulation in Advanced CKD
Aymeric Couturier, Nephrologist at the American Hospital, Member of the Clinical Research Committee of SFNDT – Francophone Society of Nephrology, Dialysis, and Transplantation shared on LinkedIn:
”Anticoagulation and Advanced CKD: Negative Results from the TRACK Study Published in JAMA
In 1,458 patients with stage 4–5 CKD or on dialysis, low-dose rivaroxaban (2.5 mg twice daily) did not reduce major cardiovascular events compared with placebo after a median follow-up of 1.7 years:
Primary endpoint:
HR 1.09 (95% CI 0.87–1.36; p=0.46)
Cardiovascular events:
22.6% vs 20.7%
Major bleeding:
- significant increase with rivaroxaban
- HR 1.51 (95% CI 1.02–2.22; p=0.04)
The trial was terminated early due to futility and suspicion of ‘net harm.’
These results contrast with those of COMPASS and VOYAGER-PAD, likely due to:
- the pro-inflammatory and pro-thrombotic profile of patients with advanced CKD,
- the lack of combination with aspirin,
- a high rate of treatment discontinuation (~28%).
- 42.1% of all deaths were sudden cardiac deaths.
Important clinical message:
Antithrombotic strategies validated in the general cardiovascular population cannot be directly extrapolated to patients with advanced kidney disease or on dialysis.
These results also raise the question of anticoagulation in atrial fibrillation among dialysis patients, an area where randomized clinical trials remain limited.”
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