Observed Apixaban Anti-Xa Levels in Obese Patients

Harkness, Weston; Pipitone, Olivia; Joss, Jacqueline D; Schiedler, Michael; Shagavah, Santon; Moore, Ryan; Hsing, Jeff

doi:10.1177/10600280221077158

Cited by 5 publications

(3 citation statements)

References 36 publications

(18 reference statements)

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“…Similarly, an observational cohort study measuring anti-Xa levels of AF or VTE patients with a BMI ≥40 kg/m 2 and/or a weight ≥120 kg who have treated with apixaban 5 mg or 2.5 mg bid, of 55 patients enrolled, 9% had peak and 6% had trough anti-Xa levels below the reference ranges. 22 Although body weight had a moderate, negative correlation with peak anti-Xa levels and a weak, inverse correlation with trough anti-Xa levels, the results showed that anti-Xa levels among obese patients are not substantially different from patients with normal BMI and weight.…”

Section: Resultsmentioning

confidence: 77%

Pharmacokinetics and Dosing Regimens of Direct Oral Anticoagulants in Morbidly Obese Patients: An Updated Literature Review

Zhao

Guo

et al. 2023

Clin Appl Thromb Hemost

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Data on the impact of morbid obesity (body mass index [BMI] ≥ 40 kg/m2) on the pharmacokinetics (PK), pharmacodynamics (PD) of direct oral anticoagulants (DOACs) are relatively limited, making it difficult to design optimal dosing regimens in morbidly obese patients. To review literature on PK/PD profile, efficacy, and safety of DOACs in venous thromboembolism (VTE) and nonvalvular atrial fibrillation (AF) patients with morbid obesity and make recommendations regarding optimal dosing regimens in these patient populations. A detailed literature search was conducted (from inception to June 22, 2022) for relevant articles involving PK/PD and clinical data on DOACs use in morbidly obese patients with VTE or AF, or healthy volunteers. A total of 28 studies were identified. DOAC-specific PK variations and clinical outcomes have been observed. Obesity may have a modest effect on PK/PD of dabigatran, apixaban, or rivaroxaban. Dabigatran was effective in AF patients with morbid obesity but might increase the risk of gastrointestinal bleeding. Standard dosing of apixaban or rivaroxaban is effective and safe for VTE and AF patients with morbid obesity. Trough edoxaban concentration and anti-Xa activity were similar in different BMI groups (18.5 to >40 kg/m2), and standard dosing of edoxaban may be effective and safe for AF patients. Current evidence suggests dabigatran should be used with caution in patients with AF as it might increase the risk of gastrointestinal bleeding; Standard dosing of apixaban or rivaroxaban can be used in VTE or AF patients; Standard dosing of edoxaban may be considered in AF patients.

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Section: Resultsmentioning

confidence: 77%

Pharmacokinetics and Dosing Regimens of Direct Oral Anticoagulants in Morbidly Obese Patients: An Updated Literature Review

Zhao

Guo

et al. 2023

Clin Appl Thromb Hemost

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“…An ambulatory assessment of anti-Xa level for obese adults and a team-based evaluation involving hematologists and, additionally, drug-level monitoring for underweight patients have been proposed as possible solutions [ 229 ]. Nevertheless, DOACs seem to be more effective and safer than OACs among all BMI patients [ 230 ].…”

Section: Discussionmentioning

confidence: 99%

Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

Lucà,

Oliva,

Abrignani

et al. 2023

JCM

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It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug–drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.

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“…A recent observational cohort study 37 was conducted in VTE and/or NVAF patients with a BMI >40 kg/m 2 and/or a weight >120 kg, treated with apixaban in the usual doses. Anti-Xa levels were routinely measured.…”

Section: Doacs For Vte Treatment and Secondary Prevention In Obese Pa...mentioning

confidence: 99%

Direct-Acting Oral Anticoagulants in patients at extremes of body weight: a review of pharmacological considerations and clinical implications

Talerico,

Pola,

Klok

et al. 2024

TH Open

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Patients at extremes of body weight are underrepresented in randomized controlled trials of direct-acting oral anticoagulants (DOACs). Therefore, their optimal anticoagulant treatment remains a topic of debate.The aim of this narrative review is to summarize the evidence on the pharmacokinetic and pharmacodynamic profile of DOACs for treating patients at extremes of body weight in venous thromboembolism (VTE) and in the prevention of cardioembolic stroke in nonvalvular atrial fibrillation (NVAF). A literature search was conducted in the main bibliographic databases, and the most relevant reviews and original articles on the topic were selected.Although data in these patient groups are limited, apixaban and rivaroxaban show a favorable pharmacokinetic and pharmacodynamic profile in obese VTE treatment and NVAF patients and, in the case of apixaban, also in underweight patients. In particular, these drugs demonstrated comparable efficacy and safety to standard therapy. Very few data were available for dabigatran and edoxaban; the latter drug was safer at a lower dose, mainly in underweight patients.Our findings are in line with the last International Society of Haemostasis and Thrombosis position paper and European Heart Rhythm Association 2021 practical guide, suggesting the use of apixaban and rivaroxaban in morbidly obese patients (>120 kg or body mass index ≥40 kg/m2) and the reduced dosage of edoxaban in low-weight patients. Future studies should focus on large populations of patients at extremes of body weights to acquire more clinical and pharmacokinetic evidence on all available DOACs, especially those currently less investigated.

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Observed Apixaban Anti-Xa Levels in Obese Patients

Cited by 5 publications

References 36 publications

Pharmacokinetics and Dosing Regimens of Direct Oral Anticoagulants in Morbidly Obese Patients: An Updated Literature Review

Pharmacokinetics and Dosing Regimens of Direct Oral Anticoagulants in Morbidly Obese Patients: An Updated Literature Review

Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

Direct-Acting Oral Anticoagulants in patients at extremes of body weight: a review of pharmacological considerations and clinical implications

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