Apixaban drug level monitoring in hemodialysis

• DOI: 10.1101/2023.06.13.23291319
• Publication Date: 2023-06-20T22:40:42Z
• Authors: Simeon Schietzel; Andreas Limacher; Matthias B. Moor; Cecilia Czerlau; Bruno Vogt; Fabienne Aregger; Dominik E. Uehlinger
• Keywords: Apixaban; Concomitant

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 January 2023. compared 2.5 mg once versus twice daily dosing. applied mixed-effects models analyses including modality, adjusted standard Kt/V, ultrafiltration dialyzer characteristics. Results 143 24 Mean (SD) age was 64.2 (15.3) years (45.2% female), median (IQR) follow up 12.5 (5.5 - 21) months. For the groups, were 54.4 (< 40 72.1) 71.3 (48.8 104.1) ng/mL (P < 0.001). Drug below detection limit 30 % 14 %. Only group (twice daily) independently associated with higher = 0.002). Follow-up did not suggest 95 th percentile exceed those non-CKD populations taking 5 daily. before bleeding (8 episodes) significantly than without subsequent bleeding: 115 (SD 51.6) 65.9 31.6) Patients took concomitant antiplatelet therapy 86% 6% In 21% patients, level monitoring resulted change Conclusion might be contributory tool to increase safety patients on hemodialysis. Further prospective outcome studies are warranted investigate possible target levels.