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Observational Study
. 2024 Jan;28(1):72-76.
doi: 10.1111/hdi.13127. Epub 2023 Nov 14.

Effect of conventional hemodialysis on the apixaban plasma concentration

Tim Poel  1 , Nikki de Rouw  2 , Nathalie C V Péquériaux  3 , Daan van de Kerkhof  4 , Annemieke M A Vermeulen Windsant  2 , Rob J van Marum  5   6 , Angele P M Kerckhoffs  1   7
Affiliations
Observational Study

Effect of conventional hemodialysis on the apixaban plasma concentration

Tim Poel et al. Hemodial Int. 2024 Jan.

Abstract

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.

Keywords: anticoagulation; apixaban; hemodialysis; nadroparin.

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References

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