Project Information

Apixaban Prescribing Patterns in Inpatients with End-Stage Renal Disease

Project Description: Apixaban is a direct oral anticoagulant approved by the FDA for use in the treated of venous thromboembolism and prevention of stroke in patients with non-valvular atrial fibrillation. The package insert includes recommendations for dose adjustments in renal impairment for non-valvular atrial fibrillation but does not suggest adjustments for the treatment of venous thromboembolism, although the drug is excreted ~25% renally and drug accumulation can be expected in renal impairment. Furthermore, initial studies prior to FDA approval of apixaban excluded patients with serum creatinine greater than 2.5 mg/dL. Pharmacokinetic studies of apixaban in patients on hemodialysis are limited to small cohorts and describe levels following once daily dosing versus the twice daily dosing that is recommended via the package insert. Therefore, more information is needed regarding the safety of apixaban in end-stage renal disease.

QPI: Bethany, Shoulders, (

Collaborators: (; (; (; Aimee, Gowler, (

Advisors: Bethany, Shoulders, (

UF Health Big Aims: Zero Harm None

MeSH Keywords: Kidney Failure, Chronic, Drug Monitoring, Factor Xa Inhibitors, Drug-Related Side Effects and Adverse Reactions, Anticoagulation