Influence of Renal Function on the Pharmacokinetics, Pharmacodynamics, Efficacy, and Safety of Non–Vitamin K Antagonist Oral Anticoagulants

  title={Influence of Renal Function on the Pharmacokinetics, Pharmacodynamics, Efficacy, and Safety of Non–Vitamin K Antagonist Oral Anticoagulants},
  author={Matthew R. Weir and Reinhold Kreutz},
  journal={Mayo Clinic Proceedings},
  • M. Weir, R. Kreutz
  • Published 1 October 2018
  • Medicine, Biology
  • Mayo Clinic Proceedings

Figures from this paper

AntiCOAgulAnt treAtment in PAtientS with AtriAl fibrillAtiOn And ChrOniC kidney diSeASe
Considering their superior safety profile and the possibility of apixaban, rivaroxaban, and edoxaban to achieve an adequate anticoagulant effect even in severe kidney disease, dOACs seem to be a better option for anticoaggulant treatment of patients with atrial fibrillation and chronic kidney disease.
Single-Dose Pharmacokinetics of Milvexian in Participants with Normal Renal Function and Participants with Moderate or Severe Renal Impairment
A single dose of milvexian 60 mg was safe and well tolerated in participants with normal renal function and moderate or severe renal impairment, and there was a similar increase in milveXian exposure between the moderate and severe renal groups.
Use of New Oral Anticoagulants / Direct Oral Anticoagulants in Malignant Patients
The use of NOACs has been increasing day by day but these agents have not completely replaced the warfarin or heparin, because of some demerits associated with the use of warfarIn and some conditions where these drugs should be avoided.
Dose discordance of direct acting oral anticoagulants using different equations for estimating GFR: a literature review
This work reviewed studies that simulated DOACs dosing in patients with atrial fibrillation by MDRD, CKD-EPI, and CG and concluded that use of CG method for DOAC's dosing is recommended in real practice.
[Safety performance of rivaroxaban versus warfarin in patients with atrial fibrillation and advanced chro-nic kidney disease].
The study provided evidence for a more beneficial safety profile of rivaroxaban compared to warfarin in patients with AF and advanced CKD.
Peripheral Artery Disease, the Factor Xa Inhibitor Rivaroxaban, and the Role of the Podiatrist
Information of the current use of antithrombotic therapy in the treatment of PAD, along with emerging data regarding the efficacy and safety of low-dose rivaroxaban plus aspirin, presents an opportunity to impact the outcomes for appropriate individuals with this disease.
Antikoagulantna terapija u bolesnika s fibrilacijom atrija i kroničnom renalnom insuficijencijom
Considering their superior safety profile as well as the possibility of achieving stable plasma levels even in severe kidney disease, NOACs seem to be a better option for anticoagulant treatment of patients with atrial fibrillation and renal insufficiency.
Concomitant diabetes with atrial fibrillation and anticoagulation management considerations
This review deals with anticoagulation treatment in patients with fibrillation and diabetes mellitus, often complicated by progressive renal impairment, where diabetic patients benefit from NOAC therapy as opposed to vitamin K antagonists to a similar extent as patients without diabetes.
Temporal trends and in‐hospital complications of catheter ablation for atrial fibrillation among patients with moderate and advanced chronic kidney diseases: 2005−2018
Real‐world data on atrial fibrillation (AF) ablation among moderate and advanced chronic kidney disease (CKD) patients have so far remained scarce, especially in‐hospital AF ablation outcomes.


Effect of renal impairment on the pharmacokinetics, pharmacodynamics, and safety of apixaban
The results suggest that dose adjustment of apixaban is not required on the basis of renal function alone and that the drug was well tolerated in this study.
Influence of Renal Impairment on the Pharmacokinetics and Pharmacodynamics of Oral Dabigatran Etexilate
Exposure to dabigatran is increased by renal impairment and correlates with the severity of renal dysfunction, and a decrease in the dose and/or an increase in the administration interval in these patients may be appropriate.
Effects of renal impairment on the pharmacokinetics, pharmacodynamics and safety of rivaroxaban, an oral, direct Factor Xa inhibitor.
Rivaroxaban clearance is decreased with increasing renal impairment, leading to increased plasma exposure and pharmacodynamic effects, as expected for a partially renally excreted drug.
Dose-finding study of rivaroxaban in hemodialysis patients.
A 10-mg dose of rivaroxaban in hemodialysis patients without residual kidney function results in drug exposure similar as published for 20mg in healthy volunteers, and there is no accumulation after multiple daily dosing.
Pharmacokinetics, safety, and tolerability of edoxaban in end-stage renal disease subjects undergoing haemodialysis.
In conclusion, based on these single-dose PK data, a supplementary dose of edoxaban may not be required following a haemodialysis session, and haemmodialysis is not an effective mechanism for removal of Edoxaban from the blood.
Population Pharmacokinetics and Pharmacodynamics of Rivaroxaban — an Oral, Direct Factor Xa Inhibitor — in Patients Undergoing Major Orthopaedic Surgery
This population analysis in patients undergoing major orthopaedic surgery demonstrated that rivaroxaban has predictable, dose-dependent pharmacokinetics that were well described by an oral one-compartment model and affected by expected covariates.
Pipe Dreams About Apixaban for Stroke Prevention in Renal Impairment
The presented data do not show that apixaban can be used safely and effectively in AF patients with severe renal impairment, and vitamin K antagonists should be preferred over anyNOAC as oral anticoagulants for patients with impaired renal function.
Pharmacokinetics and Pharmacodynamics of Edoxaban, a Non-Vitamin K Antagonist Oral Anticoagulant that Inhibits Clotting Factor Xa
Edoxaban, a once daily non-vitamin K antagonist oral anticoagulant, is a direct, selective, reversible inhibitor of factor Xa (FXa), and Oral administration of edoxaban results in rapid changes in antICOagulatory biomarkers.
Edoxaban population pharmacokinetics and exposure–response analysis in patients with non-valvular atrial fibrillation
Exposure–response analysis suggested that edoxaban Cmin and country/region are significantly associated with the incidence of bleeds, and analysis results supported a 50 % dose reduction scheme for subjects with severe renal impairment.
Population pharmacokinetics of edoxaban and its main metabolite in a dedicated renal impairment study
A model characterizing the population pharmacokinetics (PK) of edoxaban and its major metabolite, M4, following a single oral dose of 15 mg administered to subjects with varying kidney function was developed and results were in agreement with previous analyses.