Assessment of Apixaban Prescribing Patterns for Nonvalvular Atrial Fibrillation in Hospitalized Patients

Gibson, Caitlin M.; Smith, Carmen B.; Davis, Sondra; Scalese, Michael J.

doi:10.1177/1060028017726795

Cited by 20 publications

(34 citation statements)

References 8 publications

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“…Real‐world studies such as REVISIT‐US (real‐world evidence on stroke prevention in patients with atrial fibrillation in the USA) highlighted that reduced doses are more frequent in routine clinical practice when compared with clinical trials . In accordance with REVISIT‐US, 15.5% patients administered with apixaban received a reduced dose of 2.5 mg, whereas this was only 4.6% in the ARISTOTLE trial.…”

Section: Resultsmentioning

confidence: 99%

“…Likewise, a real‐world study conducted by Nguyen et al reported a reduced‐dose prescribing rate of 20.8%, which is also significantly higher than the percentage reported in ARISTOTLE. Regarding rivaroxaban, 17.3% of the patients from REVISIT‐US study and 21.7% from Nguyen et al study received a dose of 15 mg, similarly to 20.7% of the patients enrolled in ROCKET AF (reference clinical trial of rivaroxaban) . SPRINT AF also assessed the prevalence of Canadian patients eligible for the reduced dose of apixaban or rivaroxaban.…”

Section: Resultsmentioning

confidence: 99%

“…(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%

“…In a retrospective study in 3 US hospitals, with a total of 556 patients, apixaban was dosed according to FDA labelling by providers in 83.4% ( n = 464) of orders. After pharmacist review, 87.1% ( n = 484) of orders were at the approved dose, 12.2% ( n = 68) were underdosed, and 0.7% ( n = 4) were overdosed.…”

Section: Resultsmentioning

confidence: 99%

“…They should actively participate on detecting problems such as inadequate doses, nonadherence to the treatment, inadequate patient follow‐up and stopping the DOAC too soon before a surgical procedure—problems that can be the basis of half of haemorrhagic or thrombotic complications . In a multicentre retrospective study, pharmacist order review resulted in an overall 3.6% increase in appropriately dosed apixaban orders …”

Section: Discussionmentioning

confidence: 99%

See 4 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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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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…(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: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 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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The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring

Jones

King

Kim

et al. 2020

J Thromb Thrombolysis

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Prescription of DOACs in Patients with Atrial Fibrillation at Different Stages of Renal Insufficiency

Hahn,

Lamparter

2023

Adv Ther

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Atrial fibrillation (AF) and renal insufficiency often coexist and are increasingly prevalent with advancing age. Both the risk of thromboembolic events and bleeding propensity are higher in patients with AF and impaired renal function versus those with good renal health. Direct oral anticoagulants (DOACs) are being increasingly preferred over vitamin K antagonists (VKAs) in the treatment of patients with AF and impaired renal function as VKAs may accelerate progression of chronic kidney disease. DOACs, however, are eliminated by the kidneys to varying degrees, and their dosages must be adapted in accordance with renal function. Since creatinine clearance (CrCl) monitoring is recommended in patients with AF receiving DOAC therapy, CrCl must be routinely monitored in patients at the start and during the course of anticoagulation to avoid deviation from Summary of Product Characteristics dosage specifications. This review article provides an overview of current knowledge on the selection and dose of DOACs including apixaban, dabigatran, edoxaban and rivaroxaban in AF patients at different stages of renal insufficiency, with a special focus on elderly patients with comorbidities and receiving multiple medications. The groups discussed in this review include patients with varying levels of CrCl including hyperfiltration or CrCl > 90 ml/min, CrCl < 90–50 ml/min, CrCl < 50–30 ml/min, CrCl < 30–15 ml/min and end-stage renal disease or on dialysis.

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Assessment of Apixaban Prescribing Patterns for Nonvalvular Atrial Fibrillation in Hospitalized Patients

Abstract: The majority of apixaban orders for NVAF were based on FDA-approved dosages after provider entry and pharmacist review.

Cited by 20 publications

References 8 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

The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring

Prescription of DOACs in Patients with Atrial Fibrillation at Different Stages of Renal Insufficiency

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