Appropriateness of Apixaban Dosing to Prevent Stroke in Patients with Atrial Fibrillation: A Pilot Study

Carlin, Stephanie; Pickering, Jennifer; Schulman, Sam

doi:10.4212/cjhp.v69i6.1607

Cited by 8 publications

(11 citation statements)

References 6 publications

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“…Accordingly, and in agreement with the mentioned studies, more patients were being prescribed with a reduced dose of the factor Xa inhibitors than those who met the reduction criteria . Choosing lower doses reflects a greater concern by the physician to avoid bleeding complications rather than thromboembolic events …”

Section: Resultssupporting

confidence: 62%

“…It is important to note that, in ORBIT‐AF registry II (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation phase II), apixaban was the most commonly underdosed DOAC . Also, these findings are corroborated by Barra et al study and also by a small Canadian study, where a total of 47 patients were included, among whom 25 (53%) were receiving apixaban inconsistent with the ARISTOTLE trial and the product monograph.…”

Section: Resultsmentioning

confidence: 75%

“…(C) Real‐world studies results concerning dose adjustments of apixaban. (D) Results from direct oral anticoagulants overall adjustments regarding dose appropriateness…”

Section: Resultsmentioning

confidence: 99%

“…19 Choosing lower doses reflects a greater concern by the physician to avoid bleeding complications rather than thromboembolic events. 44 Real-world studies demonstrated that low doses of dabigatran and edoxaban are preferentially prescribed and their inappropriate low dosing (ILD) is greater than appropriate low dosing. This trend towards the use of ILD may be due to the reported evidence of the effectiveness of both drugs at low doses.…”

Section: Suboptimal Doacs Use In Clinical Practicementioning

confidence: 99%

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Impact of direct oral anticoagulant off‐label doses on clinical outcomes of atrial fibrillation patients: A systematic review

Santos

António

Rocha³

et al. 2020

Brit J Clinical Pharma

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Aims Worldwide observational studies are evidencing discordance between guidelines and real‐world practice regarding direct oral anticoagulant drug (DOAC) doses. This systematic review summarizes and evaluate DOACs use in real‐world practice. Methods This review was performed following the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines searching PubMed (MEDLINE) and Medscape databases. Results Data from 75 studies showed that most of the patients treated with DOACs for stroke prevention in atrial fibrillation received doses in accordance to the guidelines. However, a significant number of patients received off‐label doses (25–50% in most of the studies evaluated). DOAC overdosing was associated with increased all‐cause mortality and worse bleeding events while underdosing was associated with increased cardiovascular hospitalization and, particularly for apixaban, with a nearly 5‐fold increased risk of stroke. Conclusion Patients prescribed with off‐label DOAC doses did not receive the full benefit of anticoagulation and presented an increased risk of stroke, bleeding and/or adverse effects.

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Section: Resultssupporting

confidence: 62%

Section: Resultsmentioning

confidence: 75%

“…(C) Real‐world studies results concerning dose adjustments of apixaban. (D) Results from direct oral anticoagulants overall adjustments regarding dose appropriateness…”

Section: Resultsmentioning

confidence: 99%

Section: Suboptimal Doacs Use In Clinical Practicementioning

confidence: 99%

See 2 more Smart Citations

Impact of direct oral anticoagulant off‐label doses on clinical outcomes of atrial fibrillation patients: A systematic review

Santos

António

Rocha³

et al. 2020

Brit J Clinical Pharma

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“…36 The NOACs are typically labeled for a standard dose and a reduced dose regimen, according to specific criteria for stroke prophylaxis in atrial fibrillation and in some countries for VTE. Retrospective medical record reviews have shown a high degree of inappropriate dose selection, even in hospitals, 37,38 with many of those patients receiving a suboptimal dose. This may also be true for the patients with VTE and is thus another explanation for breakthrough events.…”

mentioning

confidence: 99%

How I treat recurrent venous thromboembolism in patients receiving anticoagulant therapy

Schulman

2017

Blood

Self Cite

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Oral anticoagulant therapy for venous thromboembolism is very effective. When oral anticoagulants are managed well, the risk of recurrence is approximately 2 per 100 patient-years. The main reasons for a breakthrough event are underlying disease and subtherapeutic drug levels. The most common underlying disease that results in recurrence on treatment is cancer. Subtherapeutic drug levels can be caused by poor adherence to the drug regimen, interactions with other drugs or food, or inappropriate dosing. It is important to investigate and understand the cause whenever such an event occurs and to improve management of anticoagulants thereby avoiding further recurrences. Here we present 4 illustrative cases together with a discussion of the underlying pathology. Whereas the mechanisms are usually quite well understood, the management of further anticoagulation after a breakthrough event is based on minimal or no clinical trial evidence.

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Appropriateness of dabigatran dosing in patients with nonvalvular atrial fibrillation (NVAF): A retrospective study conducted in a tertiary care university hospital in the eastern province of Saudi Arabia

Alali¹,

Mahmoud²,

Alharbi³

et al. 2019

Journal of the Saudi Heart Association

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BackgroundEstablishment of thromboembolism prevention remains a challenge despite the widespread consensus that thromboprophylaxis safely reduces patient morbidity and mortality. Dabigatran is a nonvitamin K antagonist oral anticoagulant (NOAC) which reduces the risk of thromboembolism. Proper dosing is important to achieve the maximum prophylactic benefit with a maintained safety profile.ObjectiveTo evaluate the appropriateness of dabigatran dosing for stroke and systemic embolism prevention in patients with nonvalvular atrial fibrillation (NVAF).MethodsThis is a retrospective cohort study of adults with NVAF. The data were collected from the electronic filing system of the hospital. Patients receiving dabigatran therapy were divided into two treatment groups according to the dose of dabigatran received. The indications for dabigatran as an oral direct anticoagulant, including age, risk of bleeding, creatinine clearance (CrCl), were collected. Appropriateness of dose reduction included any of the following factors: HAS-BLED score >2 points, age ≥75 years, or CrCl of 30–50 mL/min. The two groups were evaluated according to dose appropriateness.ResultsDabigatran dose of 110 mg was found to be inappropriately low in a large number of patients (31.3%). Multivariate regression analysis showed significant association of age and dose appropriateness (p < 0.001).ConclusionThis study revealed inappropriate prescription of reduced doses of dabigatran in a large number of patients. Age was identified as the main driving factor for underdosing. Physicians’ and pharmacists’ awareness regarding this type of high-risk medication should be improved to ensure appropriate and safe use of this commonly used drug.

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Appropriateness of Apixaban Dosing to Prevent Stroke in Patients with Atrial Fibrillation: A Pilot Study

Cited by 8 publications

References 6 publications

Impact of direct oral anticoagulant off‐label doses on clinical outcomes of atrial fibrillation patients: A systematic review

Impact of direct oral anticoagulant off‐label doses on clinical outcomes of atrial fibrillation patients: A systematic review

How I treat recurrent venous thromboembolism in patients receiving anticoagulant therapy

Appropriateness of dabigatran dosing in patients with nonvalvular atrial fibrillation (NVAF): A retrospective study conducted in a tertiary care university hospital in the eastern province of Saudi Arabia

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