Safety of Nonvitamin K Antagonists Compared with Warfarin in Patients with Atrial Fibrillation and End-Stage Kidney Disease

This study evaluated the occurrence of major bleeding following the initiation of oral anticoagulation therapy in patients with end-stage kidney disease (ESKD) in a community teaching hospital.

Target Audience

Southern Medical Journal (SMJ) is an interdisciplinary, multi-specialty Journal, and articles span the spectrum of medical topics, providing timely, up-to-date information for primary care physicians and specialists alike. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine. Therefore, the readers of the SMJ are an appropriate target for this article.

Learning Objectives

The standard of practice for oral anticoagulation (OAC) in patients with end-stage kidney disease (ESKD) has historically been warfarin, based on clinical experience and an overall lack of data demonstrating safety and efficacy of alternative agents. With the development of the nonvitamin K oral anticoagulants (NOACs), options for oral anticoagulation have greatly increased in recent years. Major guidelines give preference to the NOACs over vitamin K antagonists in a variety of patient populations. This study evaluated the occurrence of major bleeding following the initiation of oral anticoagulation therapy in patients with end-stage kidney disease (ESKD) in a community teaching hospital.

At the conclusion of the activity, learners should be better prepared to:

  • Describe the risks / benefits using apixaban instead of warfarin for anticoagulation in patients with ESRD;
  • Apply the more favorable risk / benefit profile of apixaban compared to warfarin to anticoagulation therapy for patients with ESRD.

Additional Information

Southern Medical Association
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit
Course opens: 
Course expires: 

Southern Medical Association (SMA) requires instructors, planners, managers, and all other individuals who are in a position to control the content of this activity to disclose conflicts of interest (COI) with ineligible entities within the last 24 months of the development of this activity. All identified COIs are thoroughly vetted and mitigated prior to the release of the activity. SMA is committed to providing its learners with high quality activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The following individuals, unless otherwise notedhave no relevant financial relationships to disclose.

Manuscript Author(s):
Nathan A. Pinner, PharmD
Alyssa J. Osmonson, PharmD
Jessica A. Starr, PharmD

 Southern Medical Association/Southern Medical Journal Editorial Staff:
Steven T. Baldwin, MD, SMJ Editor-in-Chief
Jennifer S. Price, MA, Managing Editor
Anita McCabe, Copyeditor

Southern Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Southern Medical Association designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA: AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. 

AANPCP: The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Healthcare Professionals: For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.  All healthcare professionals who are not MDs or DOs will receive a certificate of participation.

Available Credit

  • 1.00 AMA PRA Category 1 Credit
Please login or register to take this course.

This course from Southern Medical Association is offered for free to Mocingbird users. Log in or register to take this course.

This activity is designed to be completed within the time designated; learners should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period noted, following these steps:

  • Read the goals and objectives, accreditation information, and author disclosures.
  • Login in below to access the article in order to study the educational content and references.
  • Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score.
  • Complete the activity evaluation and attestation.