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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Prevalence of Potentially Inappropriate Apixaban Prescribing Within a Single-Centre Tertiary Hospital
Katherine J Creeper1,2,3, Grace Lenaghan4, Aaron Stockwell4
1Haematology Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Australasian Journal on Ageing
|April 17, 2026
Summary
Many patients receive incorrect apixaban doses, increasing risks. This study reviewed prescribing for atrial fibrillation (AF) and venous thromboembolism (VTE), finding significant inappropriate dosing. Targeted education is needed to improve patient outcomes.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Cardiology
Background:
- Apixaban is a recommended first-line anticoagulant for atrial fibrillation (AF) and venous thromboembolism (VTE).
- Current guidelines for apixaban dosing exist, but adherence appears inconsistent.
- Inappropriate dosing, particularly dose reduction, is linked to adverse patient outcomes.
Purpose of the Study:
- To evaluate current prescribing practices of apixaban 2.5 mg against established guidelines.
- To identify instances of potentially inappropriate prescribing of apixaban 2.5 mg.
Main Methods:
- A retrospective review of adult patients dispensed apixaban 2.5 mg at a tertiary hospital in Perth, Australia (Jan 2023 - Dec 2024).
- Data collected included demographics, indication, comorbidities, concurrent medications, and laboratory results.
- Each case was assessed against current guidelines to determine dosing appropriateness.
Main Results:
- 303 patients were dispensed apixaban 2.5 mg; 178 (59%) were newly initiated.
- Of 128 patients newly initiated for non-valvular AF, 53 (41%) received a potentially inappropriate dose.
- 19 patients (11% of cohort) received a potentially inappropriate low dose for acute VTE treatment.
Conclusions:
- A substantial number of patients initiated on apixaban 2.5 mg received doses that were potentially inappropriate.
- These findings underscore the necessity for focused anticoagulation stewardship programs.
- Enhanced clinician education is crucial for optimizing apixaban therapy and improving patient outcomes.
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