Safety and Efficacy of Apixaban Use in Peritoneal Dialysis: A Review of the Literature

Pharmacokinetics of Apixaban Among Peritoneal Dialysis Patients

Rationale & Objective

The efficacy and safety profile of apixaban remains uncertain in patients receiving peritoneal dialysis (PD) despite increasing use in this population. Accordingly, we assessed the pharmacokinetics of apixaban among patients receiving PD.

Study Design

A pharmacokinetics study in a single center. Patients recruited received 1 week of apixaban at 2.5 mg twice a day to reach steady state. Serial blood samples were then taken before and after the last dose for pharmacokinetics analysis of apixaban.

Setting & Participants

Ten stable PD patients with atrial fibrillation in an outpatient setting.

Analytical Approach/Outcomes

Pharmacokinetic parameters including the area under the concentration-time curve from time 0 to 12 hours after the last dose of apixaban (AUC0-12), peak concentration, trough level, time to peak apixaban concentration, half-life, and drug clearance were analyzed.

Results

There was a wide variation in the range of apixaban concentration across the 10 patients. The AUC0-12 for the PD group was significantly higher than those reported previously for hemodialysis patients or healthy individuals. Three patients had a supratherapeutic peak concentration whereas 2 patients had a supratherapeutic trough level as compared with the pharmacokinetic parameter in healthy individuals taking equivalent therapeutic dosage.

Limitations

Small sample size with short study duration limits the ability to ascertain the true bleeding risk and to detect any clinical outcomes. Results may be limited to Asian populations only.

Conclusions

A proportion of PD patients had supratherapeutic levels even when the reduced dosage 2.5 mg twice a day was used. Given the large interindividual variation in the drug level, therapeutic drug monitoring should be done if available. Otherwise, one should start the drug at reduced doses with caution and with more frequent clinical monitoring for any signs of bleeding.

Effectiveness of Dialysis in Psoriasis: A Short Review

Psoriasis is a chronic, incurable condition with an erratic course of symptoms and triggers by nature. Psoriasis patients need medical attention that extends beyond only treating skin conditions and joint issues. Because psoriasis is so complex, treating it with medication alone does not work well; comprehensive, whole-person treatment is required. Screening for concomitant diseases including hypertension, dyslipidemia, diabetes mellitus, cardiovascular issues, and their adverse effects like myocardial infarction and stroke is a part of treating psoriasis. Regular screening for these linked illnesses should be done. Essential elements of psoriasis care include co-medication to avoid drug interactions or drug-induced psoriasis, as well as the identification and management of trigger factors. The lack of widely used and established diagnostic criteria restricts these studies. Essential elements of psoriasis management include routine screening for these associated disorders, co-medication to avoid drug interactions or psoriasis caused by drugs, as well as the identification of trigger factors and their management. This short review highlights the effectiveness of dialysis in people with psoriasis and the fact that the benefit is more pronounced with peritoneal dialysis than with hemodialysis.