Key result
Therapeutic plasma exchange removed only 10% of the daily apixaban dose, causing no significant alteration of pharmacokinetics and no thrombotic or bleeding events.
Why the study?
Does therapeutic plasma exchange significantly alter apixaban pharmacokinetics or cause bleeding/thrombotic events in a patient on chronic apixaban therapy?
Case Report (n=1)
No
Does therapeutic plasma exchange significantly alter apixaban pharmacokinetics or cause bleeding/thrombotic events in a patient on chronic apixaban therapy?
Therapeutic plasma exchange removes only a clinically insignificant amount of apixaban, suggesting that chronic apixaban therapy can be safely continued during TPE without significant pharmacokinetic alteration.
TPE unlikely to alter apixaban exposure meaningfully; this case report leaves open its clinical role pending further study.
Therapeutic plasma exchange (TPE) is used as an effective treatment modality for a variety of autoimmune disorders. Apart from its desired effect of removing pathological blood components, it also can remove coagulation factors and drugs. Currently, there is an insufficient amount of information regarding the use of direct oral anticoagulants in this setting. In this article, we present a case report of a patient with myasthenia gravis and chronic anticoagulation with apixaban who underwent a series of TPE while continuing apixaban treatment. We observed that only 10% of daily dose was removed by the procedure and plasma levels of apixaban corresponded with expected range. TPE was not associated with shortened drug plasma half-life. We did not observe any significant alteration of apixaban pharmacokinetics during the period of TPE therapy, as well as no thrombotic or bleeding events. This case report supports the use of apixaban in patients treated by TPE, nevertheless, to firmly establish apixaban efficacy and safety profile in this clinical setting further research is needed.
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Pilková et al. (2024) conducted a case report in Myasthenia gravis (n=1). Apixaban was evaluated on Amount of apixaban eliminated by therapeutic plasma exchange. Therapeutic plasma exchange removed only 10% of the daily apixaban dose, causing no significant alteration of pharmacokinetics and no thrombotic or bleeding events.
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