Apixaban in low-weight patients with cancer-associated thrombosis: A cross sectional study of drug levels
Por:
Bravo Villa V., Romero J., Rojas-Zaldivar E., Cervantes M., Villa-Márquez M.D.R., Baz P., Cesarman-Maus G.
Publicada:
1 ene 2021
Categoría:
Hematology
Resumen:
Introduction: Apixaban, a direct factor Xa inhibitor, has been shown to be at least as safe and probably more effective than dalteparin for the treatment of cancer-associated thrombosis (CAT) as reported in the ADAM-VTE and Caravaggio studies, which included a low percentage of underweight patients. Lower-weight–based dosing is supported by cancer-specific studies such as half-dose edoxaban in the Hokusai-VTE cancer trial in individuals weighing <60 kg. Objective: To examine apixaban plasma trough levels in low-weight individuals with CAT, stably anticoagulated with full or half-dose apixaban. Methods: This was a cross-sectional study of 61 routinely treated patients with active cancer and venous thromboembolism comparing three groups: patients weighing >60 kg treated with apixaban 5 mg twice daily, patients weighing =60 kg also receiving apixaban 5 mg twice daily, and patients weighing =60 kg given half-dose apixaban (2.5 mg twice daily). Apixaban plasma steady-state trough levels were determined on a single occasion. Results: Mean apixaban plasma trough levels were similar for patients weighing >60 kg on full-dose apixaban to those weighing =60 kg taking 2.5 mg twice daily (mean, 109 ng/dL; 95% confidence interval [CI], 74-145; standard deviation [SD]: 77.6; and mean,101 ng/dL, 95% CI, 67-135; SD: 80, respectively). Mean values for low-weight patients (=60 kg) on the full 5 mg twice-daily dosing tended to be higher (mean, 136 ng/dL; 95%CI, 70-201; SD:114), without statistical significance (P =.22). Conclusions: This study supports the rationale for studying weight-based adjustments in apixaban dosing in prospective studies evaluating safety and efficacy of dose reduction in low-weight patients with cancer. © 2021 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).
Filiaciones:
Bravo Villa V.:
Hematology Department, Instituto Nacional de Cancerología, México City, CDMX, Mexico
Romero J.:
Hematology Department, Instituto Nacional de Cancerología, México City, CDMX, Mexico
Rojas-Zaldivar E.:
Hematology Department, Instituto Nacional de Cancerología, México City, CDMX, Mexico
Cervantes M.:
Clinical Laboratory, Instituto Nacional de Cancerología, México City, CDMX, Mexico
Villa-Márquez M.D.R.:
Laboratorio Privado de Genética, México City, Mexico
Baz P.:
Hematology Department, Instituto Nacional de Cancerología, México City, CDMX, Mexico
Cesarman-Maus G.:
Hematology Department, Instituto Nacional de Cancerología, México City, CDMX, Mexico
All Open Access, Gold
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