Evaluating Prescribing Practices of Apixaban in the Elderly

Area of Science:

• Pharmacology
• Geriatrics
• Clinical Pharmacy

Background:

• Apixaban is a widely used anticoagulant.
• Appropriate dosing is critical for efficacy and safety, especially in elderly populations.
• Prescribing practices require ongoing evaluation.

Purpose of the Study:

• To assess apixaban prescribing patterns in elderly patients across various clinical settings.
• To identify discrepancies between prescribed and recommended apixaban dosages.
• To evaluate adherence to Food and Drug Administration (FDA) labeling guidelines.

Main Methods:

• Retrospective chart review of 1,045 elderly patients (≥65 years) initiated on apixaban.
• Analysis of prescribing data from outpatient and inpatient settings.
• Evaluation of dosing based on FDA labeling criteria (age, weight, serum creatinine).

Main Results:

• 16.2% of analyzed patients (1,039) received an incorrect apixaban dose.
• Lower-than-indicated doses were more common in atrial fibrillation patients (75% of incorrect doses).
• Hemodialysis patients were excluded from the primary analysis.

Conclusions:

• Elderly patients may be at risk for underdosing with apixaban, potentially impacting treatment outcomes.
• Pharmacist involvement in anticoagulation stewardship is vital for optimizing apixaban therapy.
• Further research into optimizing apixaban dosing strategies for geriatric populations is warranted.