Use of specific anti-Xa levels in acute kidney injury to transition patients from oral factor Xa inhibitors to i.v. heparin infusion
Autor: | Kiara M Oltman, Sara Zochert, Michael P. Gulseth, Thaddaus R. Hellwig, Brittany M Elgersma |
---|---|
Rok vydání: | 2019 |
Předmět: |
Male
Acute decompensated heart failure Pyridones Administration Oral Kidney 030226 pharmacology & pharmacy Sepsis 03 medical and health sciences 0302 clinical medicine Rivaroxaban medicine Humans 030212 general & internal medicine Infusions Intravenous Aged Venous Thrombosis Pharmacology Drug Substitution Heparin business.industry Health Policy Acute kidney injury Acute Kidney Injury Middle Aged medicine.disease Thrombosis Pulmonary embolism Renal Elimination Atrial Flutter Anesthesia Pyrazoles Female Apixaban Drug Monitoring Pulmonary Embolism business Factor Xa Inhibitors medicine.drug |
Zdroj: | American Journal of Health-System Pharmacy. 76:505-511 |
ISSN: | 1535-2900 1079-2082 |
Popis: | Purpose This case series presents 3 patients with acute kidney injury taking apixaban or rivaroxaban and transitioning to a heparin infusion. Summary Case 1 was a 78-year-old man admitted with respiratory failure, acute decompensated heart failure, and acute kidney injury. He was taking apixaban for atrial flutter. He was transitioned to an i.v. heparin infusion and had 2 consecutive heparin antifactor-Xa levels greater than 2 units/mL. Heparin was held and resumed about 36 hours later when the apixaban anti-Xa level was less than 50 ng/mL. Case 2 was a 55-year-old man admitted with acute kidney injury, taking apixaban for a recent deep vein thrombosis. Apixaban anti-Xa levels were monitored and i.v. heparin was initiated when the level was less than 100 ng/mL, about 56 hours after the last apixaban dose. Case 3 was a 64-year-old woman admitted with sepsis and acute kidney injury taking rivaroxaban for pulmonary embolism, which occurred 2 weeks prior to admission. Rivaroxaban anti-Xa levels were monitored and i.v. heparin was initiated about 36 hours after the last dose when the level was less than 100 ng/mL. The management strategy did not lead to any thrombotic outcomes; however, 1 patient experienced bleeding. Conclusion Specific anti-Xa levels for rivaroxaban and apixaban appeared to be helpful in the transition of 3 patients to unfractionated heparin infusions in the setting of acute kidney injury. These levels provided enhanced, individualized care and likely helped avoid over and under anticoagulation. |
Databáze: | OpenAIRE |
Externí odkaz: | |
Nepřihlášeným uživatelům se plný text nezobrazuje | K zobrazení výsledku je třeba se přihlásit. |