Low-Dose Anticoagulant Alternative Could Prevent Strokes in Dialysis Patients

An alternative to warfarin could help reduce the risk of stroke in kidney failure patients on dialysis.

Patients with kidney failure who undergo dialysis have an extremely high prevalence of atrial fibrillation, meaning they are at a higher risk of stroke compared with the general population.

Although the anticoagulant warfarin prevents nearly two-thirds of strokes in patients withatrial fibrillation, its efficacy in dialysis patients was unclear.

In a study published in theJournal of the American Society of Nephrology, investigators sought to assess the potential of the oral drug apixaban, which more directly inhibits coagulation than warfarin.

For the study, 7 patients received a low dose of apixaban at a dosage of 2.5 mg, twice daily for 8 days. Blood samples were collected before and after apixaban administration on nondialysis days 1 and 8.

Between days 1 and 8, there was a significant accumulation of the drug with the 2.5 mg dose, according to the study.

Apixaban levels were measured hourly on day 9 after a 2.5 mg dose, and the investigators found that only 4% of the drug was removed.

After a 5-day washout period, 5 patients received the currently recommended 5 mg dose of apixaban, twice daily for 8 days. The investigators found that it led to supratherapeutic blood levels of the drug.

“This dosage should be avoided in patients on dialysis,” said lead investigator Thomas Mavrakanas, MD. “On the contrary, drug exposure with the reduce 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.”