Reduced dose, but not reduced risk: rates of inappropriate apixaban dose reduction and stroke and bleeding incidence

Abstract Introduction Patients with atrial fibrillation (AF) should be prescribed standard-dose (5mg twice daily) apixaban for stroke prevention unless they meet 2 or more criteria: age ≥80, weight ≤60kg, and/or creatinine ≤1.5mg/dL, in which case a reduced-dose (2.5mg is indicated. Despite this, some clinicians may also prescribe to patients who do not criteria dose reduction, an effort reduce bleeding risk. Purpose To assess prescribing patterns AF based on reduction and characterize baseline demographics incidence of ischemic stroke, major bleeding, intracranial hemorrhage (ICH) stratified by standard-dose, appropriately reduced-dose, inappropriately apixaban. Methods Using pooled data from 8 large hospitals PCORnet, multicenter national healthcare research network, we assessed the standard AF, additional stratification 2.5mg presence absence 2+ reduction. We then characteristics 5-year event rate ICH death. Results Of 45,947 available dosing information, 38,861 (85%) were 5mg 7086 (15%) 2.5mg. 2.5mg, 4321 (61%) did reduced likely female have comorbidities such as heart failure, hypertension, prior stroke. These trends pronounced meeting adjustment than those (Table 1). Unadjusted analyses found significantly experience all-cause had highest rates each event, but without at elevated risk 2). Conclusion Many Because are older cardiovascular factors, their death exceeds that full treated patients. risks exist both suggesting potential under-treatment majority dose-reduced Funding Acknowledgement Type funding sources: Private company. Main source(s): Bayer