Abstract
BackgroundPatients on dialysis are at higher risk of major bleeding and recurrent thrombosis creating acute venous thromboembolism (VTE) treatment challenges. DOACs represent an interesting option but there are concerns of bioaccumulation and increased bleeding risk. Anti-Xa trough levels may be used to monitor for bioaccumulation but there is little data.Case presentationWe describe a case, a 51 yo female, 36 kg on hemodialysis with a provoked acute upper extremity deep vein thrombosis in whom body habitus and calciphylaxis contraindicated the use of standard therapy. She received apixaban 2.5 mg twice daily for 6 weeks. The apixaban anti-Xa trough levels were measured weekly 12 h after the morning dose and ranged from 58 to 84 ng/mL, similar to expected levels with normal renal function. There were no adverse events in the 3 months follow-up.ConclusionsWe saw no evidence of bioaccumulation indicating a potential role for low dose apixaban for acute VTE in dialysis patients.
Highlights
Patients on dialysis are at higher risk of major bleeding and recurrent thrombosis creating acute venous thromboembolism (VTE) treatment challenges
We saw no evidence of bioaccumulation indicating a potential role for low dose apixaban for acute VTE in dialysis patients
Roberge and Wells Thrombosis Journal (2021) 19:23 circumstances, apixaban might be the best option for VTE management in end stage renal disease (ESRD) and dialysis
Summary
Initiation of anticoagulation in patients with end stage renal disease (ESRD) and on chronic hemodialysis, who develop a venous thromboembolic event (VTE), is challenging since the rate of recurrent thrombosis and major bleeding are increased [1]. A right upper extremity ultrasound revealed a segmental nonocclusive thrombus in the lower part of the right internal jugular vein (IJV) She had an angiogram and was diagnosed with a severe brachiocephalic vein in-stent stenosis and a moderate stenosis along the juxta-anastomotic cephalic vein fistula. The patient was reporting worsening pain and swelling over the right side of her neck and her right arm for the last week As such we diagnosed an acute right upper extremity deep vein thrombosis, most likely provoked by the initial flow disturbance caused by the in-stent stenosis and thereafter by the angiographic intervention. She was treated as an outpatient with apixaban 2.5 mg twice daily for 6 weeks. There were no adverse events in the 3 months after anticoagulation initiation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
