Betrixaban for Deep Venous Thrombosis Prevention in a Patient with End-Stage Renal Disease on Intermittent Hemodialysis

Betrixaban is an oral factor Xa inhibitor that is indicated for venous thromboembolism (VTE) prophylaxis in hospitalized patients. It has minimal renal excretion, but it is not well studied in patients with severe renal dysfunction or patients with end-stage renal disease (ESRD). In this evaluation, we discuss betrixaban use in a patient with ESRD on intermittent hemodialysis (HD) and a history of heparin-induced thrombocytopenia (HIT) and contraindication to heparin therapy due to a positive platelet factor 4 IgG antibody. The patient was started on betrixaban for VTE prophylaxis, dosed as 80 mg once followed by 40 mg daily for a total of 15 days of therapy before they were discharged. The patient was continued on their home dialysis schedule of three times weekly and received a total of seven sessions of HD while admitted. Several anti-Xa levels collected after the second dose of betrixaban ranged between 0.12 and 0.32 IU/mL, which were within the predicted therapeutic range for betrixaban based on previous pre-clinical studies. A trough level drawn on day 7 of 0.15 IU/mL indicated the absence of accumulation. Betrixaban was well tolerated with no reported bleeding or VTE events. This case report demonstrates the successful use of betrixaban without accumulation for a patient with ESRD on HD. Betrixaban may be a potential choice when standard options are unsuitable for VTE prophylaxis or in patients with contraindications to other treatments.