Abstract
Apixaban is a factor Xa inhibitor and is used in patients undergoing
haemodialysis treatment. Apixaban can be cleared by haemodialysis, which
might lead to decreased apixaban plasma concentrations and insufficient
anticoagulation during and after haemodialysis. The objective of this
study was to investigate the effect of haemodialysis on apixaban plasma
concentrations in patients treated with apixaban 2,5 mg twice daily on
conventional haemodialysis with standard low molecular weight heparin
(LMWH) anticoagulation ( nadroparin 3800-7600IU). 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 reference range. Anti-Xa levels have
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. There seems to be no need for dose
adjustments of apixaban and co-administration of LMWH next to apixaban
might be unnecessary.