Author: Leo
Keywords: apixaban | dialysis | atrial fibrillation
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| From google images |
Recent studies have shown that patients with hemodialysis atrial fibrillation should avoid the use of apixaban 5 mg, bid, but can use low-dose apixaban 2.5 mg, bid instead of warfarin to prevent stroke.
Hemodialysis patients with atrial fibrillation rate of about 20%; In addition, hemodialysis patients with ischemic or hemorrhagic stroke risk is higher than the general population. And widely used in clinical anticoagulant - warfarin whether the end stage renal disease (ESRD), atrial fibrillation has a protective effect is not clear.
Apiprazine is a novel oral anticoagulant that inhibits clotting factor Xa. For the first time in 2012, the FDA-approved drug label showed that patients with creatinine clearance <25 ml / min should not use the drug. In 2014, the United States (non-Europe or Canada) to modify the drug label, said late or end-stage chronic kidney disease patients can also use apixababan, the recommended dose of 5 mg.
Studies have shown that ESRD patients with apixaban standard dosage (ie, 5 mg, bid) drug exposure is too high. To further explore the potential role of alternative anticoagulants, Dr. Thomas Mavrakanas, Ph.D., of the Harvard Medical School, conducted a single-center, open-label cohort study of seven patients with advanced chronic kidney disease (mean age 62 years) , Aiming to investigate the steady-state plasma concentrations of apixaban in patients with stable hemodialysis, ie, the rate of drug absorption and the rate of elimination. The results were published online March 16 in the American Journal of Nephrology (JASN).
The results showed that patients taking low-dose apixaban (2.5 mg, bid) 8 days, the patient's plasma concentration increased significantly, the first 9 days of treatment of patients with apixaban level, the results showed that only 4% of the drug by dialysis The
After 5 days of clearance, five patients received standard doses of apixaban 5 mg, bid. Drug exposure increased significantly, higher than the normal 90% of patients with renal function.
"ESRD patients use 5 mg, bid for overexposure at least 36% of the drug, and avoid the use of standard doses to prevent bleeding," the investigators said.
The study shows that dialysis patients can safely use low-dose apixaban, but still need to be randomized to confirm the trial.
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