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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
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Critical Analysis of Apixaban Dose Adjustment Criteria
Anh Vu1, Tao T Qu1, Rachel Ryu2
1Department of Pharmacy Practice, Loma Linda University School of Pharmacy, CA, USA.
Summary
Apixaban dose adjustments for non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE) may require re-evaluation. Clinical data suggest current criteria may not impact apixaban safety or efficacy in specific patient groups.
Area of Science:
- Pharmacology
- Clinical Medicine
- Drug Safety
Background:
- Apixaban is prescribed for non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE).
- Dosing adjustments for apixaban in NVAF are based on age, weight, and renal function, unlike VTE treatment.
- These adjustment criteria are unconventional compared to other anticoagulants.
Purpose of the Study:
- To critically analyze apixaban dosing adjustment criteria.
- To evaluate the outcomes associated with apixaban dose adjustments.
Main Methods:
- Literature search of PubMed from March 2013 to March 2020.
- Keywords: "apixaban," "dose adjustment," "adjustment," "adjustment criteria."
- Analysis of pharmacokinetic and clinical data.
Main Results:
- Pharmacokinetic studies indicate higher apixaban exposure in elderly patients (>65 years), those with extreme body weights, and impaired renal function.
- Clinical data reveal no compromise in apixaban safety or efficacy for patients >75 years, <60 kg, or with eGFR <50 mL/min, including those on dialysis.
- Variable dosing strategies are observed in clinical practice.
Conclusions:
- Current apixaban dose adjustment criteria may warrant re-evaluation.
- Clinical evidence suggests potential for revised dosing guidelines.
- Further research into apixaban dosing optimization is recommended.
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