• 文献检索
  • 文档翻译
  • 深度研究
  • 学术资讯
  • Suppr Zotero 插件Zotero 插件
  • 邀请有礼
  • 套餐&价格
  • 历史记录
应用&插件
Suppr Zotero 插件Zotero 插件浏览器插件Mac 客户端Windows 客户端微信小程序
定价
高级版会员购买积分包购买API积分包
服务
文献检索文档翻译深度研究API 文档MCP 服务
关于我们
关于 Suppr公司介绍联系我们用户协议隐私条款
关注我们

Suppr 超能文献

核心技术专利:CN118964589B侵权必究
粤ICP备2023148730 号-1Suppr @ 2026

文献检索

告别复杂PubMed语法,用中文像聊天一样搜索,搜遍4000万医学文献。AI智能推荐,让科研检索更轻松。

立即免费搜索

文件翻译

保留排版,准确专业,支持PDF/Word/PPT等文件格式,支持 12+语言互译。

免费翻译文档

深度研究

AI帮你快速写综述,25分钟生成高质量综述,智能提取关键信息,辅助科研写作。

立即免费体验

阿哌沙班在一名需要长期血液透析的终末期肾病患者中的临床应用及药效学监测

Clinical Application and Pharmacodynamic Monitoring of Apixaban in a Patient with End-Stage Renal Disease Requiring Chronic Hemodialysis.

作者信息

Kufel Wesley D, Zayac Adam S, Lehmann David F, Miller Christopher D

机构信息

Department of Pharmacy, Upstate University Hospital, Syracuse, New York.

Department of Medicine, Upstate Medical University, Syracuse, New York.

出版信息

Pharmacotherapy. 2016 Nov;36(11):e166-e171. doi: 10.1002/phar.1836. Epub 2016 Oct 14.

DOI:10.1002/phar.1836
PMID:27643979
Abstract

Despite prescribing guidance, limited data exist to describe the use of apixaban in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD). Current apixaban dosing recommendations for this patient population are based largely on a single-dose pharmacokinetic study of eight patients. We describe the clinical application and pharmacodynamic monitoring of apixaban in a 62-year-old 156-kg African-American woman with nonvalvular atrial fibrillation and ESRD requiring hemodialysis who developed calciphylaxis while receiving warfarin therapy. Based on a multidisciplinary clinical judgment decision due to concern for drug accumulation after multiple doses in patients with ESRD receiving HD, she was anticoagulated with apixaban 2.5 mg twice/day, as opposed to 5 mg twice/day as recommended by the package insert. Antifactor Xa monitoring was used, and resultant peak and trough apixaban concentrations were above the upper limit of detection for our clinical laboratory (more than 2.00 IU/ml). On day 7 of her hospitalization, the patient developed gastrointestinal bleeding, and apixaban was discontinued; no further clinical signs of bleeding occurred during her subsequent hospitalization course. Use of the Naranjo Adverse Drug Reaction Probability Scale indicated a probable relationship (score of 6) between apixaban exposure and the manifestation of gastrointestinal bleeding. The patient ultimately died 44 days after the acute bleeding event; however, coagulation concerns were not implicated in the patient's death. To our knowledge, this is the first case report that describes apixaban use and associated antifactor Xa monitoring in a patient with ESRD receiving HD, and it provides concern for current apixaban dosing recommendations in this patient population. Further pharmacokinetic and clinical data are likely necessary to better characterize apixaban use in these patients to optimize safety and efficacy.

摘要

尽管有用药指南,但关于阿哌沙班在需要血液透析(HD)的终末期肾病(ESRD)患者中的使用情况,现有数据有限。目前针对该患者群体的阿哌沙班给药建议主要基于对8名患者的单剂量药代动力学研究。我们描述了一名62岁、体重156公斤的非裔美国女性,患有非瓣膜性心房颤动和ESRD且需要血液透析,在接受华法林治疗时发生钙化防御,使用阿哌沙班的临床应用及药效学监测情况。由于担心接受HD的ESRD患者多次给药后药物蓄积,基于多学科临床判断决定,给予她阿哌沙班2.5毫克每日两次进行抗凝,而不是按照药品说明书推荐的5毫克每日两次。采用抗Xa因子监测,结果显示阿哌沙班的峰浓度和谷浓度高于我们临床实验室的检测上限(超过2.00国际单位/毫升)。住院第7天,患者出现胃肠道出血,停用阿哌沙班;在随后的住院过程中未再出现出血的临床症状。使用Naranjo药物不良反应概率量表表明,阿哌沙班暴露与胃肠道出血表现之间可能存在关联(评分为6)。该患者最终在急性出血事件发生44天后死亡;然而,凝血问题与患者死亡无关。据我们所知,这是第一例描述在接受HD的ESRD患者中使用阿哌沙班及相关抗Xa因子监测的病例报告,它引发了对该患者群体当前阿哌沙班给药建议的关注。可能需要更多的药代动力学和临床数据,以更好地描述这些患者使用阿哌沙班的情况,从而优化安全性和有效性。

相似文献

1
Clinical Application and Pharmacodynamic Monitoring of Apixaban in a Patient with End-Stage Renal Disease Requiring Chronic Hemodialysis.阿哌沙班在一名需要长期血液透析的终末期肾病患者中的临床应用及药效学监测
Pharmacotherapy. 2016 Nov;36(11):e166-e171. doi: 10.1002/phar.1836. Epub 2016 Oct 14.
2
Reprint of: Efficacy and safety of apixaban compared to warfarin for nonvalvular atrial fibrillation in end-stage renal disease on hemodialysis.重复:在终末期肾病血液透析患者中非瓣膜性心房颤动中阿哌沙班与华法林的疗效和安全性比较。
J Am Pharm Assoc (2003). 2024 Jul-Aug;64(4S):102160. doi: 10.1016/j.japh.2024.102160. Epub 2024 Aug 15.
3
Influence of apixaban on antifactor Xa levels in a patient with acute kidney injury.阿哌沙班对急性肾损伤患者抗Xa因子水平的影响。
Am J Health Syst Pharm. 2016 Apr 15;73(8):563-7. doi: 10.2146/ajhp150360.
4
The Successful Use of Apixaban in Dialysis Patients with Calciphylaxis Who Require Anticoagulation: A Retrospective Analysis.阿哌沙班在需要抗凝治疗的合并钙化防御透析患者中的成功应用:一项回顾性分析。
Am J Nephrol. 2018;48(3):168-171. doi: 10.1159/000491881. Epub 2018 Sep 3.
5
Safety of apixaban compared to warfarin in hemodialysis patients: Do antiplatelets make a difference?阿哌沙班与华法林相比在血液透析患者中的安全性:抗血小板药物有影响吗?
Eur J Haematol. 2021 May;106(5):689-696. doi: 10.1111/ejh.13599. Epub 2021 Mar 8.
6
Safety and Efficacy of Apixaban Versus Warfarin in Patients With Advanced Chronic Kidney Disease.阿哌沙班与华法林用于晚期慢性肾脏病患者的安全性和疗效。
Ann Pharmacother. 2018 Nov;52(11):1078-1084. doi: 10.1177/1060028018781853. Epub 2018 Jun 5.
7
Efficacy and safety of apixaban compared to warfarin for nonvalvular atrial fibrillation in end-stage renal disease on hemodialysis.在接受血液透析的终末期肾病患者中,阿哌沙班与华法林相比用于非瓣膜性心房颤动的疗效和安全性。
J Am Pharm Assoc (2003). 2024 Mar-Apr;64(2):457-462. doi: 10.1016/j.japh.2023.12.020. Epub 2023 Dec 25.
8
Major bleeding in patients with atrial fibrillation receiving apixaban or warfarin: The ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation): Predictors, Characteristics, and Clinical Outcomes.服用阿哌沙班或华法林的房颤患者的大出血:ARISTOTLE 试验(阿哌沙班用于减少房颤中的中风和其他血栓栓塞事件):预测因素、特征和临床结局。
J Am Coll Cardiol. 2014 May 27;63(20):2141-2147. doi: 10.1016/j.jacc.2014.02.549. Epub 2014 Mar 19.
9
Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Previous Stroke or Transient Ischemic Attack.非瓣膜性心房颤动且既往有卒中和短暂性脑缺血发作患者中应用阿哌沙班、达比加群和利伐沙班与华法林的有效性和安全性。
Stroke. 2017 Aug;48(8):2142-2149. doi: 10.1161/STROKEAHA.117.017474. Epub 2017 Jun 27.
10
Effectiveness and Safety of Dabigatran, Rivaroxaban, and Apixaban Versus Warfarin in Nonvalvular Atrial Fibrillation.达比加群、利伐沙班和阿哌沙班与华法林相比治疗非瓣膜性心房颤动的有效性和安全性。
J Am Heart Assoc. 2016 Jun 13;5(6):e003725. doi: 10.1161/JAHA.116.003725.

引用本文的文献

1
Apixaban dosing in hemodialysis - can drug level monitoring mitigate controversies?阿哌沙班在血液透析中的剂量 - 药物水平监测能否缓解争议?
BMC Nephrol. 2024 Oct 9;25(1):338. doi: 10.1186/s12882-024-03782-w.
2
Apixaban anti-Xa level monitoring in treatment of acute upper extremity deep vein thrombosis for patient on chronic hemodialysis: a case report.阿哌沙班抗Xa水平监测在慢性血液透析患者急性上肢深静脉血栓治疗中的应用:一例报告
Thromb J. 2021 Apr 1;19(1):23. doi: 10.1186/s12959-021-00277-8.
3
Apixaban successfully resolved a warfarin-resistant left atrial appendage thrombus in a patient with end-stage renal disease on hemodialysis.
阿哌沙班成功溶解了一名接受血液透析的终末期肾病患者的对华法林耐药的左心耳血栓。
Anatol J Cardiol. 2019 Mar;21(3):174-175. doi: 10.14744/AnatolJCardiol.2019.66789.
4
Atrial fibrillation and chronic kidney disease: A review of options for therapeutic anticoagulation to reduce thromboembolism risk.心房颤动与慢性肾脏病:降低血栓栓塞风险的治疗性抗凝方案综述
Clin Cardiol. 2018 Oct;41(10):1395-1402. doi: 10.1002/clc.23085. Epub 2018 Oct 25.
5
Safety analysis of apixaban versus warfarin in patients with advanced kidney disease.阿哌沙班与华法林用于晚期肾病患者的安全性分析。
J Thromb Thrombolysis. 2018 Aug;46(2):246-252. doi: 10.1007/s11239-018-1683-5.
6
Clinical Pharmacology of Oral Anticoagulants in Patients with Kidney Disease.口服抗凝药物在肾脏病患者中的临床药理学。
Clin J Am Soc Nephrol. 2019 Feb 7;14(2):278-287. doi: 10.2215/CJN.02170218. Epub 2018 May 25.
7
Use of direct oral anticoagulants for the prevention and treatment of thromboembolic disease in patients with reduced renal function: a short review of the clinical evidence.直接口服抗凝剂在肾功能减退患者血栓栓塞性疾病预防和治疗中的应用:临床证据简述
Ther Clin Risk Manag. 2017 Apr 6;13:447-454. doi: 10.2147/TCRM.S88911. eCollection 2017.