PB0458 - Pharmacokinetic Analysis of Apixaban in Patients with End Stage Renal Disease Undergoing Dialysis, Real World Data From a Tertiary Centre in London, UK – A Retrospective Audit

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

JB

John K. Bartoli-Abdou, PhD

Anticoagulation Development & VTE Prevention Lead Pharmacist
Centre for Haemostasis & Thrombosis, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
London, England, United Kingdom

Co-Author(s)

UC

Ubonphan Chaichana

Pharmacist
Department of Pharmacy, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
London, England, United Kingdom
NM

Natasha Moore

Highly Specialist Renal Pharmacist
Department of Pharmacy, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
London, England, United Kingdom
LW

Li Wei

Lead of Pharmacoepidemiology and Medication Safety Research Cluster
School of Pharmacy, University College London, London, UK
London, England, United Kingdom
VC

Victoria Collings

Consultant Pharmacist - Haemostasis & Thrombosis
Centre for Haemostasis & Thrombosis, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
London, England, United Kingdom
Victoria Speed, PhD

Specialist Anticoagulation Pharmacist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
AD

Andrew J. Doyle

Consultant Haematologist
Centre for Haemostasis & Thrombosis, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
London, England, United Kingdom
NK

Nicola Kumar

Consultant Nephrologist
Department of Nephrology, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
London, England, United Kingdom
Karen A. Breen, MD

Consultant Haematologist
Guy's & St Thomas' NHS Foundation Trust
London, England, United Kingdom

Background: Apixaban is a potential alternative oral option for anticoagulation in patients unsuitable for vitamin-K antagonists (VKAs) in end stage renal disease (ESRD) undergoing dialysis. Apixaban is the direct oral anticoagulant with least renal clearance at 27%. Evidence about the impact of ESRD and dialysis on apixaban pharmacokinetics varies, with evidence suggesting dialysis does not impact apixaban pharmacokinetics while elsewhere evidence suggests apixaban exposure increases.

Aims: To evaluate trough pharmacokinetics of apixaban in dialysis to determine if they deviate from the reference literature in the general population.

Methods: We report pre-dialysis trough anti-Xa levels in patients undergoing dialysis prescribed apixaban 2.5mg BD at a tertiary centre in London, UK. Levels were taken as part of routine care between 01/01/2020 and 15/06/2022. Descriptive statistics and t-tests were used to compare continuous variables.

Results: 85 trough anti-Xa levels from 28 patients were identified with a median (IQR) age of 61.5years (44.5-73.5), Table 1. 15 (53.6%) patients were anticoagulated for atrial fibrillation (AF) and 12 (42.9%) for secondary prevention of venous thromboembolism (VTE). All trough levels in AF were below the upper limit of normal (ULN) of International Council for Standardization in Haematology (ICSH) reference range for apixaban 2.5mg, Figure 1. In VTE, 6 (19%) levels were above the ULN for apixaban 2.5mg in VTE. Levels were normally distributed and all were within the reference range for apixaban 5mg for the relevant indications. The VTE cohort consistently lower trough levels than in AF (Sig=0.035).

Conclusion(s): Our data suggests apixaban pharmacokinetics in patients undergoing dialysis is consistent with the general population. Apixaban exposure was not increased or equivalent to patients taking apixaban 5mg BD in the general population as has been reported in the literature. The pharmacokinetic profiles in AF and VTE are distinct and reference ranges used in clinical practice should reflect this.