Key result
Utilization of apixaban anti-Xa levels aided in the transition from apixaban to warfarin in a patient with chronic renal failure and avoided the need for parenteral bridging therapy.
Why the study?
Transitioning from apixaban to warfarin is complicated by apixaban effects on INR and anti-Xa assays, particularly in renal dysfunction where drug persistence prolongs INR effects and therapeutic anticoagulation.
Does the utilization of apixaban anti-Xa levels safely guide the transition from apixaban to warfarin without parenteral bridging in a patient with chronic renal dysfunction?
Case Report (n=1)
No
Does the utilization of apixaban anti-Xa levels safely guide the transition from apixaban to warfarin without parenteral bridging in a patient with chronic renal dysfunction?
Chromogenic apixaban anti-Xa assays can be utilized to safely guide the transition from apixaban to warfarin without parenteral bridging in patients with renal dysfunction and delayed apixaban clearance.
May aid apixaban-to-warfarin transition without bridging in renal dysfunction; leaves open need for prospective validation.
PURPOSE: The effect of apixaban on anti-factor Xa (anti-Xa) assays and international normalized ratio (INR) complicates transitions between anticoagulant agents. When switching from apixaban to warfarin, the recommendation is to begin both a parenteral anticoagulant and warfarin at the time of the next apixaban dose and to discontinue the parenteral agent when the INR is in an acceptable range. This proves challenging in renal dysfunction, as continued presence of apixaban contributes to both a prolonged effect on the INR and continued therapeutic levels of anticoagulation. SUMMARY: This case describes the transition of apixaban to warfarin in a patient with acute on chronic kidney disease and recent deep vein thrombosis, utilizing chromogenic apixaban anti-Xa assays to assess the level of anticoagulation and avoid unnecessary parenteral anticoagulation. CONCLUSION: Utilization of apixaban anti-Xa levels aided in the transition from apixaban to warfarin in a patient with chronic renal failure and avoided need for parenteral bridging therapy.
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Elgersma et al. (2021) conducted a case report in Chronic renal dysfunction and recent deep vein thrombosis (n=1). Apixaban anti-Xa level monitoring was evaluated on Need for parenteral bridging therapy. Utilization of apixaban anti-Xa levels aided in the transition from apixaban to warfarin in a patient with chronic renal failure and avoided the need for parenteral bridging therapy.
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