Key result
Half-dose apixaban in patients ≤60 kg achieves comparable trough levels to full-dose in heavier patients.
Why the study?
Studies establishing apixaban for cancer-associated thrombosis included few underweight patients, leaving uncertainty regarding apixaban plasma trough levels in low-weight individuals treated with full or half-dose regimens.
Does half-dose or full-dose apixaban in low-weight patients (≤60 kg) with cancer-associated thrombosis result in similar plasma trough levels compared to standard full-dose apixaban in patients weighing >60 kg?
Cross-Sectional (n=61)
No
Does half-dose or full-dose apixaban in low-weight patients (≤60 kg) with cancer-associated thrombosis result in similar plasma trough levels compared to standard full-dose apixaban in patients weighing >60 kg?
Patients weighing ≤60 kg with cancer-associated thrombosis receiving half-dose apixaban (2.5 mg twice daily) achieve plasma trough concentrations similar to patients >60 kg receiving full-dose apixaban (5 mg twice daily), supporting further prospective research into weight-adjusted apixaban dosing.
May inform weight-adjusted dosing in cancer thrombosis; leaves open prospective trials before practice change.
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. 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.
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Villa et al. (2021) conducted a cross-sectional in Cancer-associated thrombosis (CAT) (n=61). Low body weight (≤60 kg) on half-dose apixaban (2.5 mg twice daily) or full-dose apixaban (5 mg twice daily) vs. Patients weighing >60 kg receiving full-dose apixaban (5 mg twice daily) was evaluated on Apixaban plasma steady-state trough levels (ng/dL) (95% CI 67-135, p=0.22). Half-dose apixaban (2.5 mg BID) in patients ≤60 kg produced mean trough levels (101 ng/dL) comparable to full-dose (5 mg BID) in patients >60 kg (109 ng/dL).
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