Medication non‐adherence as a cause of apixaban failure in venous thromboembolism: The importance of pharmacist medication reconciliation

Abstract

Venous thromboembolism is often treated with direct oral anticoagulants. In order for direct oral anticoagulants to be effective, patients must adhere to a specific dosing strategy. We report a case of apixaban failure, the clinical workup that ensued, and the eventual discovery of unsuccessful medication adherence as the cause.

Trust but verify: A case report of unintended medication omission

“…Jethwa et al describe a 58‐year‐old male admitted to the hospital for deep vein thrombosis. 7 Three weeks prior, the patient had been hospitalized for pulmonary emboli and started on apixaban, and although he described a 2‐day period of nonadherence immediately after discharge, he reported strict compliance since that time. With his new deep vein thrombosis, treatment failure was the leading diagnosis on the differential.…”

“…Recently, a similar case of medication nonadherence masquerading as treatment failure was reported. Jethwa et al describe a 58‐year‐old male admitted to the hospital for deep vein thrombosis 7 . Three weeks prior, the patient had been hospitalized for pulmonary emboli and started on apixaban, and although he described a 2‐day period of nonadherence immediately after discharge, he reported strict compliance since that time.…”

Trust but Verify: A Case of Unintended Medication Omission

“…However, the medical team later consulted pharmacy to review the patient's outpatient medication fill history and only at that time did the patient's persistent nonadherence become clear. Adherence verification prevented mislabeling the patient as failing apixaban and avoided warfarin therapy and bridging with a parenteral anticoagulant [7].…”