Apixaban : Low Dose of Warfarin Alternative May Prevent Stroke in Dialysis Patients

Highlights

• Warfarin is the commonly used anticoagulant to prevent stroke.
• There is no clear data available on the use of warfarin for prevention of stroke in dialysis patients.
• Apixaban drug is found to be a low dose alternative drug for warfarin in dialysis patients to prevent stroke.

An alternative anticoagulant to warfarin, when given at a low dose to dialysis patients, can be maintained in the blood to prevent stroke, finds a recent study published in the Journal of the American Society of Nephrology (JASN). The study also found additional benefits of apixaban drug in patients with kidney failure.

Patients who have kidney failure and are on dialysis were found to have a high prevalence of atrial fibrillation which is a common heart arrhythmia. These people are at a higher risk of stroke when compared to the general population.

The most commonly known blood thinner, warfarin is found to prevent nearly two-thirds of stroke in the general population with atrial fibrillation. However, its efficacy in dialysis patients is still found to be unclear, and therefore it is necessary to test alternative anticoagulants.

Testing the Potential of Apixaban
The research team led by Thomas Mavrakanas, MD and Mark Lipman, MD (Jewish General Hospital at McGill University, in Canada) was found to assess the potential of a low dose warfarin alternative - apixaban.

The oral drug is found to directly inhibit coagulation when compared to warfarin. The study was conducted on seven patients who received a low dose of apixaban (2.5mg) twice daily.

Findings
The research team collected the blood samples and found a significant accumulation of the drug between day 1 and 8.

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The drug levels were monitored hourly during dialysis, and only 4% of the drug was removed.

After five days, when five of the patients received recommended dose of 5mg of apixaban twice daily for 8 days. They showed dangerously high blood levels of the drug.

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Dr. Mavrakanasm currently a research fellow at Brigham & Women’s Hospital in Boston, said, "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."

"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."

Apixaban Drug
Apixaban drug is prescribed to prevent stroke or blood clots in people who have atrial fibrillation, which is not caused by any heart valve disease. The drug is also used for the treatment of blood clots such as deep vein thrombosis and pulmonary embolism in people who have a hip replacement or knee replacement surgery.

Apixaban acts by blocking the certain natural substances that help the blood clots to form.

The drug comes in the form of a tablet to be taken by mouth. It is taken twice a day either with food or on an empty stomach.

Side Effects

• Bleeding gums
• Chest pain
• Swelling
• Headache
• Difficulty in breathing
• Nose bleeds
• Wheezing

References

1. Dr. Thomas A. Mavrakanas et.al., 'Apixaban Pharmacokinetics at Steady State in Hemodialysis Patients', Journal of the American Society of Nephrology (2017); 10.1681/ASN.2016090980
2. Apixaban - (https://medlineplus.gov/druginfo/meds/a613032.html)

Source-Medindia