Prevalence of Potentially Inappropriate Apixaban Prescribing Within a Single-Centre Tertiary Hospital

Apixaban is widely recommended as first line therapy for atrial fibrillation (AF) and venous thromboembolism (VTE). Despite the widespread availability of dosing guidelines, anecdotal evidence suggests clinicians do not routinely follow these recommendations. Inappropriate dose reduction is associated with suboptimal patient outcomes. This project aimed to review current prescribing practices of apixaban 2.5 mg against guidelines to identify potentially inappropriate prescribing.

A single-centre, retrospective review of all adult patients admitted to a large tertiary hospital in Perth, Australia, who were dispensed apixaban 2.5 mg between 1 January 2023 and 31 December 2024, was undertaken. Patients were identified via dispensing records. Demographics, indication, comorbidities, concurrent medications and laboratory data were collated. Each case was assessed against current guidelines to determine whether dosing was appropriate or potentially inappropriate. Data were analysed using quantitative statistics.

A total of 303 patients were dispensed apixaban 2.5 mg in the audit period. Of these 178 (59%) were newly initiated. The mean age of the cohort was 79 years (standard deviation [SD] 12.6), with 49% female. Of the 128 patients (72%) newly initiated on apixaban 2.5 mg for non-valvular AF, 53 (41%) patients received a potentially inappropriate dose. A further 19 patients (11% of the entire cohort) received a potentially inappropriately low dose for acute VTE treatment.

A significant proportion of patients initiated on apixaban 2.5 mg received potentially inappropriate doses. These findings highlight the need for targeted anticoagulation stewardship and clinician education to optimise patient outcomes.