Lee Sun Hack, Kim Mijin, Kim Min Sun, Choe Jeongcheon, Ahn Jinhee, Lee Hyewon, Choi Junghyun, Lee Han Cheol, Kim Hyerim, Cha Kwang Soo
Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, Korea.
Department of Laboratory Medicine and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, Korea.
Blood Res. 2025 Jul 7;60(1):39. doi: 10.1007/s44313-025-00089-z.
Apixaban is recommended for patients with atrial fibrillation. Although routine monitoring of plasma concentrations is not typically advised, factors such as ethnicity, sex, and comorbidities can influence these levels. Our study analyzed the plasma apixaban concentrations (PAC) in patients to explore whether these levels, along with underlying conditions, offer enhanced insights for risk stratification.
This study analyzed 49 patients with atrial fibrillation who had been taking apixaban for over a month, examined factor Xa levels within 6 h post-administration, and correlated PAC with clinical characteristics such as age, body weight, estimated glomerular filtration rate (eGFR), presence of heart failure, and bleeding events.
The mean plasma concentration of apixaban in all patients was 160.3 ± 77.5 ng/mL. Those taking apixaban 5 mg twice daily had higher plasma concentrations than those taking 2.5 mg twice daily (191.2 ± 75.3 ng/mL vs. 137.2 ± 72.0 ng/mL, p = 0.014). Among the patients receiving a reduced dose, renal function and heart failure were significantly associated with plasma concentrations. No factors were associated with the plasma concentrations in patients receiving the standard dose. Notably, reduced-dose patients with heart failure had plasma concentrations comparable to those of individuals receiving the standard dose and exhibited a higher incidence of bleeding than the other groups.
PAC measurement revealed that apixaban dosages, classified based on age, body weight, and eGFR, were generally effective. Nonetheless, heart failure may increase plasma levels and correlate with an increased bleeding risk in Korean patients on reduced doses. Therefore, tailoring apixaban prescriptions to account for heart failure and other comorbidities may enhance treatment efficacy.
阿哌沙班被推荐用于心房颤动患者。尽管通常不建议常规监测血浆浓度，但种族、性别和合并症等因素会影响这些水平。我们的研究分析了患者的血浆阿哌沙班浓度（PAC），以探讨这些水平以及潜在病情是否能为风险分层提供更深入的见解。
本研究分析了49例服用阿哌沙班超过1个月的心房颤动患者，在给药后6小时内检测Xa因子水平，并将PAC与年龄、体重、估计肾小球滤过率（eGFR）、心力衰竭的存在以及出血事件等临床特征相关联。
所有患者的阿哌沙班平均血浆浓度为160.3±77.5 ng/mL。每日两次服用5 mg阿哌沙班的患者血浆浓度高于每日两次服用2.5 mg的患者（191.2±75.3 ng/mL对137.2±72.0 ng/mL，p = 0.014）。在接受减量治疗的患者中，肾功能和心力衰竭与血浆浓度显著相关。在接受标准剂量的患者中，没有因素与血浆浓度相关。值得注意的是，心力衰竭的减量治疗患者血浆浓度与接受标准剂量的个体相当，并且出血发生率高于其他组。
PAC测量显示，根据年龄、体重和eGFR分类的阿哌沙班剂量总体上是有效的。尽管如此，心力衰竭可能会增加血浆水平，并与韩国减量治疗患者出血风险增加相关。因此，根据心力衰竭和其他合并症调整阿哌沙班处方可能会提高治疗效果。
