Can a Single Measurement of Apixaban Levels Identify Patients at Risk of Overexposure? A Prospective Cohort Study
| Autor: | de Vries, Tim A.C., Hirsh, Jack, Bhagirath, Vinai C., Ginsberg, Jeffrey S., Pisters, Ron, Hemels, Martin E.W., de Groot, Joris R., Eikelboom, John W., Chan, Noel C. |
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| Přispěvatelé: | Cardiology, Graduate School, ACS - Heart failure & arrhythmias |
| Rok vydání: | 2022 |
| Předmět: |
Economics and Econometrics
Biological variation population Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] Forestry Drug monitoring Factor Xa inhibitors RC666-701 Materials Chemistry Media Technology Diseases of the circulatory (Cardiovascular) system Off-label use Original Article Blood coagulation tests Biological variation individual |
| Zdroj: | TH Open: Companion Journal to Thrombosis and Haemostasis Th Open, 6, e10-e17 TH Open, Vol 06, Iss 01, Pp e10-e17 (2022) TH open : companion journal to thrombosis and haemostasis, 6(1), e10-e17 Th Open, 6, 1, pp. e10-e17 |
| ISSN: | 2512-9465 2567-3459 |
| DOI: | 10.1055/s-0041-1740492 |
| Popis: | Background Patients with atrial fibrillation (AF) are frequently treated with apixaban 2.5-mg twice daily (BID) off-label, presumably to reduce the bleeding risk. However, this approach has the potential to increase the risk of ischemic stroke. If a single measurement could reliably identify patients with high drug levels, the increased stroke risk may be mitigated by confining off-label dose reduction to such patients. Objectives This study aimed to determine whether a single high apixaban level is predictive of a similarly high level when the test is repeated in 2 months. Methods In this prospective cohort study of clinic patients receiving apixaban 5-mg BID for AF or venous thromboembolism, peak and trough apixaban levels were measured using the STA-Liquid anti-Xa assay at baseline and 2 months. We calculated the proportions of patients with levels that remained in the upper quintile. Results Of 100 enrolled patients, 82 came for a second visit, 55 of whom were treated with apixaban 5-mg BID. Seven (63.6%, 95% confidence interval [CI]: 35.4–84.8%) and nine (81.8%, 95% CI: 52.3–94.9%) of 11 patients with a baseline trough and peak level in the upper quintile, respectively, had a subsequent level that remained within this range. Only one (9.1%, 95% CI: 1.6–37.7%) patient had a subsequent level that fell just lower than the median. Conclusion The trough and peak levels of apixaban in patients who have a high level on a single occasion, usually remain high when the assay is repeated in 2 months. Accordingly, the finding of a high apixaban level in patients deemed to be at high risk of bleeding, allows physicians contemplating off-label use of the 2.5-mg BID dose to limit its use to selected patients who are less likely to be exposed to an increased risk of thrombosis. |
| Databáze: | OpenAIRE |
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