Towers William, Nguyen Steffany N, Ruegger Melanie C, Salazar Eric, Donahue Kevin R
Houston Methodist Hospital-Texas Medical Center, Houston, TX, USA.
Ann Pharmacother. 2022 Jun;56(6):656-663. doi: 10.1177/10600280211046087. Epub 2021 Sep 18.
Oral direct factor Xa inhibitors (FxaIs) are renally eliminated; thus, acute kidney injury (AKI) may increase the risk for drug accumulation and bleeding. There is minimal data describing the effects of AKI on FxaI anti-Xa levels or clinical outcomes.
To compare anti-Xa level monitoring with standard monitoring in patients who experience AKI on apixaban or rivaroxaban.
This retrospective study included patients admitted within a large hospital system from May 2016 to October 2020. Patients were included if they received apixaban or rivaroxaban prior to AKI. Patients were stratified into 1 of 2 groups: those with anti-Xa level monitoring or those who received standard monitoring. The primary outcome was major bleeding as defined by the International Society of Thrombosis and Haemostasis.
A total of 196 patients were included in the final analysis. Major bleeding occurred in 2 patients who received anti-Xa level monitoring, compared with 14 patients who received standard monitoring (2.1% vs 14%; < 0.01). Variables identified as predictors of major bleeding included a documented history of liver disease (adjusted odds ratio = 3.17; 95% CI = 1.04-9.67; = 0.04) and antiplatelet use (adjusted odds ratio = 4.18; 95% CI = 1.28-13.7; = 0.02).
This is the first study to demonstrate that anti-Xa level monitoring was associated with a significant reduction in major bleeding compared with standard monitoring in patients with AKI who received apixaban or rivaroxaban. The optimal management of antithrombotic medications in patients with AKI and recent exposure to an FxaI requires further investigation.
口服直接凝血因子Xa抑制剂（FxaIs）通过肾脏排泄；因此，急性肾损伤（AKI）可能增加药物蓄积和出血风险。关于AKI对FxaI抗Xa水平或临床结局影响的数据极少。
比较阿哌沙班或利伐沙班治疗期间发生AKI的患者中抗Xa水平监测与标准监测的情况。
这项回顾性研究纳入了2016年5月至2020年10月在一个大型医院系统内住院的患者。纳入在发生AKI之前接受过阿哌沙班或利伐沙班治疗的患者。患者被分为两组中的一组：接受抗Xa水平监测的患者或接受标准监测的患者。主要结局是国际血栓与止血学会定义的大出血。
最终分析共纳入196例患者。接受抗Xa水平监测的患者中有2例发生大出血，而接受标准监测的患者中有14例发生大出血（2.1%对14%；<0.01）。被确定为大出血预测因素的变量包括有肝病记录史（调整比值比=3.17；95%置信区间=1.04-9.67；=0.04）和使用抗血小板药物（调整比值比=4.18；95%置信区间=1.28-13.7；=0.02）。
这是第一项表明在接受阿哌沙班或利伐沙班治疗且发生AKI的患者中，与标准监测相比，抗Xa水平监测可显著减少大出血的研究。对于近期使用过FxaI且发生AKI的患者，抗血栓药物的最佳管理仍需进一步研究。
