Initial Apixaban Dosing in Patients with Atrial Fibrillation.
Clin Cardiol. 2018 Mar 15;:
Authors: Buchholz A, Ueberham L, Gorczynska K, Dinov B, Hilbert S, Dagres N, Husser D, Hindricks G, Bollmann A
BACKGROUND: Apixaban is a non-vitamin K oral anticoagulant and has been approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Current labelling recommends dose reduction based on patients age, weight and renal function.
OBJECTIVES: The aim of this study was to analyze adherence to current labeling instructions concerning initial apixaban dosing in clinical practice and to identify factors associated with inappropriate dose reduction.
METHODS: Patients with AF initiated on apixaban in 2016, were identified in the Heart Center Leipzig database. Health records were screened to identify patient characteristics, prescribed apixaban dose, renal function, and further dosing-relevant secondary diagnoses and co-medication.
RESULTS: We identified a total of 569 consecutive patients with AF initiated on apixaban. In 301 (52.9%) patients apixaban was prescribed in standard dose (5 mg b.i.d.) and in 268 (47.1%) in reduced dose (2.5 mg b.i.d.). Of 268 patients receiving a reduced dose, 163 (60.8%) did not meet labeling criteria for dose reduction. In uni- and multivariate regression analysis, age (OR 0.736, 95% CI 0.664-0.816, P<0.0001), patient weight (OR 1.120, 95% CI 1.076-1.166, P<0.0001) and serum creatinine level (OR 0.910, 95% CI 0.881-0.940, P<0.0001) were the only independent predictors for apixaban underdosage.
CONCLUSIONS: In clinical practice, apixaban dosing is frequently incoherent with labelling. Factors associated with inappropriate dose reduction are age, patient weight and serum creatinine level, the same factors that are used as criteria for dose adjustment. However, in underdosed patients, the three factors did not meet the criteria-rule for dose reduction.
PMID: 29542830 [PubMed - as supplied by publisher]