Washington, DC (March 16, 2017) -- New research suggests that an alternative to warfarin, when given at a low dose to dialysis patients, can be maintained in the blood at safe levels for potentially preventing strokes. The findings, which appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN), indicate that additional research is warranted on the benefits of apixaban in patients with kidney failure.
Kidney failure patients on dialysis have a very high prevalence of atrial fibrillation, a common heart arrhythmia. As a result, they are at higher risk of stroke than the general population. The blood thinner warfarin prevents nearly two thirds of strokes in the general population of patients with atrial fibrillation, but because its effectiveness in dialysis patients is unclear, it is important to test alternative anticoagulants.
A team led by Thomas Mavrakanas, MD and Mark Lipman, MD (Jewish General Hospital at McGill University, in Canada) assessed the potential of apixaban, an oral drug that more directly inhibits coagulation than warfarin. For the study, 7 patients received a low dose of apixaban (2.5 mg) twice daily.
When the researchers collected blood samples, they found significant accumulation of the drug between day 1 and 8. When apixaban levels were monitored hourly during dialysis, only 4% of the drug was removed. After a 5-day washout period, 5 patients received the currently recommended dose of 5 mg of apixaban twice daily for 8 days. This led to dangerously high blood levels of the drug.
"This dosage should be avoided in patients on dialysis. On the contrary, drug exposure with the reduced dose of 2.5 mg twice daily may be considered in patients on dialysis with atrial fibrillation," said Dr. Mavrakanas, who is currently a research fellow at Brigham & Women's Hospital in Boston. "No clinical data are yet available, however, and more evidence is necessary before recommending this drug at the 2.5 mg twice daily dose for stroke prevention in patients on dialysis with atrial fibrillation."
Study co-authors include Caroline Samer, MD, Sharon Nessim, MD, and Gershon Frisch, MD.
Disclosures: The authors reported no financial disclosures.
The article, entitled "Apixaban pharmacokinetics at steady state in hemodialysis patients," will appear online at http://jasn.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 17,000 members representing 112 countries. For more information, please visit http://www.