Correlation Between Trough Plasma Dabigatran Concentrations and Estimates of Glomerular Filtration Rate Based on Creatinine and Cystatin C |
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| Authors: | Paul K. L. Chin Daniel F. B. Wright Mei Zhang Mary C. Wallace Rebecca L. Roberts David M. Patterson Berit P. Jensen Murray L. Barclay Evan J. Begg |
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| Affiliation: | .Department of Clinical Pharmacology, Christchurch Hospital, 2 Riccarton Avenue, Christchurch, 8011 New Zealand ;.Department of Medicine, University of Otago, Christchurch, New Zealand ;.School of Pharmacy, University of Otago, Dunedin, New Zealand ;.Canterbury Health Laboratories, Christchurch, New Zealand ;.Surgical Sciences, Dunedin School of Medicine, Dunedin, New Zealand |
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| Abstract: | AimsDabigatran is largely cleared by renal excretion. Renal function is thus a major determinant of trough dabigatran concentrations, which correlate with the risk of thromboembolic and haemorrhagic outcomes. Current dabigatran dosing guidelines use the Cockcroft–Gault (CG) equation to gauge renal function, instead of contemporary equations including the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations employing creatinine (CKD-EPI_Cr), cystatin C (CKD-EPI_Cys) and both renal biomarkers (CKD-EPI_CrCys).MethodsA linear regression model including the dabigatran etexilate maintenance dose rate, relevant interacting drugs and genetic polymorphisms (including CES1), was used to analyse the relationship between the values from each renal function equation and trough steady-state plasma dabigatran concentrations.ResultsThe median dose-corrected trough steady-state plasma dabigatran concentration in 52 patients (38–94 years) taking dabigatran etexilate was 60 µg/L (range 9–279). The dose-corrected trough concentration in a patient on phenytoin and phenobarbitone was >3 standard deviations below the cohort mean. The CG, CKD-EPI_Cr, CKD-EPI_Cys and CKD-EPI_CrCys equations explained (R2, 95 % CI) 32 % (9–55), 37 % (12–60), 41 % (16–64) and 47 % (20–69) of the variability in dabigatran concentrations between patients, respectively. One-way analysis of variance (ANOVA) comparing the R2 values for each equation was not statistically significant (p = 0.74).DiscussionEstimates of renal function using the four equations accounted for 32–47 % of the variability in dabigatran concentrations between patients. We are the first to provide evidence that co-administration of phenytoin/phenobarbitone with dabigatran etexilate is associated with significantly reduced dabigatran exposure.Electronic supplementary materialThe online version of this article (doi:10.1007/s40268-014-0045-9) contains supplementary material, which is available to authorized users. |
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