Key result
Conventional hemodialysis reduces apixaban plasma concentrations ~27% but levels remain within the reference range.
Why the study?
The effect of hemodialysis on apixaban plasma concentrations in patients treated with this factor Xa inhibitor was unknown.
Does conventional hemodialysis affect apixaban plasma concentrations in patients receiving apixaban 2.5 mg twice daily?
Observational
Does conventional hemodialysis affect apixaban plasma concentrations in patients receiving apixaban 2.5 mg twice daily?
Absolute Event Rate: 102.71% vs 141.03%
p-value: p=0.003
Conventional hemodialysis significantly reduces apixaban plasma concentrations, but levels remain within the therapeutic reference range, suggesting no need for dose adjustments.
Apixaban levels stay in range post-hemodialysis; leaves open need for outcome trials before any dosing guidance.
PURPOSE: Apixaban is a factor Xa inhibitor used in patients undergoing hemodialysis treatment. The objective of this study is to investigate the effect of hemodialysis on apixaban plasma concentrations. METHODS: This observational study is on patients treated with apixaban 2.5 mg twice daily on conventional hemodialysis with standard low-molecular-weight heparin (LMWH) anticoagulation (nadroparin 3800-7600 IU). Plasma blood samples were collected before starting dialysis (t1), 2 h after starting dialysis (t2), and directly after dialysis (t3). Apixaban concentration was measured before and after dialysis. Anti-Xa activity was measured for all three samples. RESULTS: A significant difference was observed between the apixaban concentration before and after dialysis (mean before dialysis 141.03 ng/mL; mean after dialysis 102.71 ng/mL; p = 0.003). Nonetheless, both apixaban plasma concentrations and anti-Xa levels remained within the reference range. Anti-Xa levels had a strong correlation with the apixaban concentrations (r = 0.935, p = 0.000). Thus, anti-Xa activity might be used as a surrogate for apixaban plasma concentration. CONCLUSION: There seems to be no need for dose adjustments of apixaban; co-administration of LMWH next to apixaban might also be unnecessary.
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Poel et al. (2023) conducted an observational in Hemodialysis. Conventional hemodialysis vs. Before dialysis was evaluated on Apixaban plasma concentration (p=0.003). Conventional hemodialysis significantly reduced apixaban plasma concentrations from 141.03 ng/mL to 102.71 ng/mL (p=0.003), but levels remained within the reference range.
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