TY - JOUR
T1 - Effect of conventional hemodialysis on the apixaban plasma concentration
AU - Poel, Tim
AU - de Rouw, Nikki
AU - Péquériaux, Nathalie C. V.
AU - van de Kerkhof, Daan
AU - Windsant, Annemieke M. A. Vermeulen
AU - van Marum, Rob J.
AU - Kerckhoffs, Angele P. M.
N1 - Publisher Copyright: © 2023 The Authors. Hemodialysis International published by Wiley Periodicals LLC on behalf of International Society for Hemodialysis.
PY - 2024/1
Y1 - 2024/1
N2 - 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.
AB - 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.
KW - anticoagulation
KW - apixaban
KW - hemodialysis
KW - nadroparin
UR - http://www.scopus.com/inward/record.url?scp=85176906938&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/hdi.13127
DO - https://doi.org/10.1111/hdi.13127
M3 - Article
C2 - 37962053
SN - 1492-7535
VL - 28
SP - 72
EP - 76
JO - Hemodialysis international
JF - Hemodialysis international
IS - 1
ER -