Institute of Pharmacology.
Institute of Pharmacology; Corresponding author: Jan Miroslav Hartinger, Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
Pharmazie. 2024 Aug 1;79(7):159-162. doi: 10.1691/ph.2024.4550.
Therapeutic plasma exchange (TPE) is used as an effective treatment modality for a variety of autoimmune disorders. Apart from its desired effect of removing pathological blood components, it also can remove coagulation factors and drugs. Currently, there is an insufficient amount of information regarding the use of direct oral anticoagulants in this setting. In this article, we present a case report of a patient with myasthenia gravis and chronic anticoagulation with apixaban who underwent a series of TPE while continuing apixaban treatment. We observed that only 10% of daily dose was removed by the procedure and plasma levels of apixaban corresponded with expected range. TPE was not associated with shortened drug plasma half-life. We did not observe any significant alteration of apixaban pharmacokinetics during the period of TPE therapy, as well as no thrombotic or bleeding events. This case report supports the use of apixaban in patients treated by TPE, nevertheless, to firmly establish apixaban efficacy and safety profile in this clinical setting further research is needed.
治疗性血浆置换（TPE）被用作治疗多种自身免疫性疾病的有效方法。除了去除病理性血液成分的预期效果外，它还可以去除凝血因子和药物。目前，关于在这种情况下使用直接口服抗凝剂的信息还不够充分。在本文中，我们报告了一例患有重症肌无力和慢性抗凝治疗的患者，在继续使用阿哌沙班的同时进行了一系列 TPE。我们观察到，该过程仅去除了 10%的日剂量，阿哌沙班的血浆水平与预期范围相符。TPE 并未导致药物血浆半衰期缩短。在 TPE 治疗期间，我们没有观察到阿哌沙班药代动力学的任何显著改变，也没有发生血栓或出血事件。本病例报告支持 TPE 治疗患者使用阿哌沙班，但为了在这种临床环境中更确定地确立阿哌沙班的疗效和安全性，还需要进一步的研究。
