Successful Treatment Using Apixaban in a Patient on Hemodialysis with Uremic Calciphylaxis.

Calciphylaxis is a rare but serious condition in which microvessel occlusion occurs within the subcutaneous adipose tissue and dermis, leading to painful lesions. End-stage renal disease requiring hemodialysis and warfarin therapy can increase the risk of calciphylaxis. In this report, we describe the evaluation and treatment of a 75-year-old female patient with warfarin-induced calciphylaxis who presented unique symptoms. The patient required intensive care unit admission due to hemodynamic instability, which was treated with inotropes and broad-spectrum intravenous antibiotics. This description of the patient's unusual symptoms has the potential to provide insights needed to improve the diagnosis of future patients. Due to the unavailability of FDA-approved treatment for calciphylaxis, its management is based on data from observational studies and clinical experience.

Comparing the Efficacy and Safety of Apixaban Versus Warfarin in Morbidly Obese Patients.

This study was conducted to evaluate the efficacy and safety of apixaban versus warfarin in morbidly obese patients. A total of 250 morbidly obese patients with a body mass index (BMI) higher than 40 kg/m2 or a body weight higher than 120 kg who were on anticoagulation therapy with either apixaban or warfarin for over one month were included in the study. This retrospective cohort, multicenter study was executed using the medical records of 125 morbidly obese patients treated with apixaban, while patients on warfarin were selected using a systemic random sampling to match the sample size of the apixaban group. There was no significant difference between apixaban and warfarin in the development of thromboembolic events and major bleeding. However, incidences of minor bleeding significantly decreased in the apixaban group compared to patients treated with warfarin. This difference was overcome by controlling serum creatinine and nonsteroidal anti-inflammatory drugs (NSAIDs). In conclusion, apixaban efficacy and safety are nearly the same as that of warfarin in morbidly obese patients with a lower incidence of minor bleeding with apixaban. Controlling serum creatinine and NSAIDs use may improve warfarin safety and decrease its complications.