In hemodialysis patients, median apixaban drug levels were significantly higher with 2.5 mg twice daily (71.3 ng/mL) compared to 2.5 mg once daily (54.4 ng/mL), without evidence of accumulation.
Observational (n=24)
No
Does apixaban 2.5 mg twice daily compared to 2.5 mg once daily result in higher drug levels in adult chronic hemodialysis patients?
In hemodialysis patients, apixaban 2.5 mg twice daily results in higher drug levels than once daily without exceeding non-CKD reference ranges, though higher levels and concomitant antiplatelet therapy may increase bleeding risk.
Absolute Event Rate: 71.3% vs 54.4%
p-value: p=<0.001
Abstract Background Apixaban is increasingly being used in hemodialysis patients. However, uncertainty remains regarding appropriate dosing and risk of accumulation. Methods We analyzed apixaban drug levels from a tertiary care dialysis unit collected between August 2017 and January 2023. We compared 2.5 mg once versus twice daily dosing. We applied mixed-effects models analyses including dialysis modality, adjusted standard Kt/V, ultrafiltration and dialyzer characteristics. Results We analyzed 143 apixaban drug levels from 24 patients. Mean (SD) age was 64.2 (15.3) years (45.2% female), median (IQR) follow up 12.5 (5.5 - 21) months. For the 2.5 mg once and twice daily groups, median (IQR) drug levels were 54.4 (< 40 - 72.1) and 71.3 (48.8 - 104.1) ng/mL (P < 0.001). Drug levels were below the detection limit in 30 % and 14 %. Only dosing group (twice versus once daily) was independently associated with higher drug levels (P = 0.002). Follow-up did not suggest accumulation. 95 th percentile did not exceed those of non-CKD populations taking 5 mg twice daily. Drug levels before a bleeding (8 episodes) were significantly higher than those without a subsequent bleeding: 115 (SD 51.6) versus 65.9 (SD 31.6) ng/mL (P < 0.001). Patients with versus without a bleeding took concomitant antiplatelet therapy in 86% versus 6% (P < 0.001). In 21% of patients, drug level monitoring resulted in change of dosing. Conclusion Apixaban drug monitoring might be a contributory tool to increase safety in patients on hemodialysis. Further prospective outcome studies are warranted to investigate possible target levels.
Schietzel et al. (Tue,) conducted a observational in Chronic hemodialysis (n=24). Apixaban vs. 2.5 mg once daily was evaluated on Median apixaban drug level (ng/mL) (p=<0.001). In hemodialysis patients, median apixaban drug levels were significantly higher with 2.5 mg twice daily (71.3 ng/mL) compared to 2.5 mg once daily (54.4 ng/mL), without evidence of accumulation.