Abstract

Opinion

Use of Rivaroxaban and Apixaban, Two Non-Vitamin K Antagonist Oral Anticoagulants (NOACs), in Renally Impaired Patients - the limits of our knowledge

Kenneth T Moore* and Maria Langas

Published: 11 October, 2018 | Volume 3 - Issue 3 | Pages: 049-051

Patients with chronic kidney disease are at increased risk of thromboembolic complications and are therefore often managed with anticoagulation therapy [1]. While these patients are traditionally treated with Vitamin K antagonists (VKAs), the Non-Vitamin K antagonist oral anticoagulants (NOACs), such as rivaroxaban and apixaban are being used with increasing frequency. Relatively new to the anticoagulant treatment arsenal, both compounds are direct Factor Xa inhibitors and represent an alternative to traditional VKA treatments, such as warfarin. However, because these compounds are at least partially renally eliminated, achieving safe and effective anticoagulation in this vulnerable population has proven to be a challenge [2,3]. With limited published data, there is often uncertainty surrounding which of the NOACs can be safely used.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001026 Cite this Article Read Full Article PDF

Keywords:

Renal Impairment; Rivaroxaban; Apixaban

References

  1. Lutz J, Jurk K, Schinzel H. Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations. Int J Nephrol Renovasc Dis. 2017; 10: 135-143. Ref.: https://goo.gl/MBu8sA
  2. Xarelto [package insert]. Raritan, NJ. Janssen Pharmaceutical Companies. 2011 (revised October 2017).
  3. Eliquis [package insert]. Princeton, NJ: Bristol-Myers Squibb Company. 2012 (revised February 2018).
  4. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365: 883-891. Ref.: https://goo.gl/JZux9g
  5. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365: 981-992. Ref.: https://goo.gl/vuXaQr
  6. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, et al. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2009; 361: 1139-1151. Ref.: https://goo.gl/fs8ha2
  7. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, et al. Edoxaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2013; 369: 2093-2104. Ref.: https://goo.gl/XXRm3h
  8. Kubitza D, Becka M, Mueck W, Halabi A, Maatouk H, et al. Effects of renal impairment on the pharmacokinetics, pharmacodynamics and safety of rivaroxaban, an oral, direct factor Xa inhibitor. Br J Clin Pharmacol. 2010; 70: 703-712. Ref.: https://goo.gl/uENJM7
  9. Chang M, Yu Z, Shenker A, Wang J, Pursley J, et al. Effect of renal impairment on the pharmacokinetics pharmacodynamics, and safety of apixaban. J Clin Pharmacol. 2010; 56: 637-645. Ref.: https://goo.gl/Ukqwgs
  10. Dias C, Moore KT, Murphy J, Ariyawansa J, Smith W, et al. Pharmacokinetics, pharmacodynamics, and safety of single-dose rivaroxaban in chronic hemodialysis. Am J Nephrol. 2016; 43: 229-236. Ref.: https://goo.gl/2kb1sU
  11. Wang X, Tirucherai G, Marbury TC, Wang J, Chang M, et al. Pharmacokinetics, pharmacodynamics, and safety of apixaban in subjects with end-stage renal disease on hemodialysis. J Clin Pharmacol. 2016; 56: 628-636. Ref.: https://goo.gl/3Jrgm4

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More