Arrhythmias & electrophysiologyResearch article
Clinical Patterns and Appropriateness of Apixaban Dosing in Patients With Atrial Fibrillation
- Electronic health record data from PCORnet health systems
Authors' conclusion
In clinical practice, reduced-dose apixaban accounts for approximately 15% of prescriptions, with the majority (61%) prescribed in individuals who do not meet the labeling criteria for dose reduction.
Study context
- Population
- Patients with atrial fibrillation (AF)/atrial flutter (AFL) treated with apixaban between 2015 and 2019 in US PCORnet health systemsreceived apixaban, among 280,709 patients with AF/AFL
- Participants
- 45,947 patients
- Comparison
- Inappropriate low-dose apixaban vs appropriate full-dose apixaban
Main finding
As reported in the abstract
Apixaban use and dose
Received apixaban
45,947 (16.4%)
Full-dose (of apixaban recipients)
84.6%
Reduced-dose (of apixaban recipients)
15.4%
Among reduced-dose recipients, did not meet the criteria for dose reduction
61.0%
Further findings
| Outcome | adjusted HR (95% CI) | |
|---|---|---|
| Mortality, ischemic stroke, intracranial hemorrhage · median follow-up of 2.2 years — inappropriate low-dose apixaban vs appropriate full-dose apixaban · mortality · exploratory outcomes | 1.77 (1.66–1.88) | |
| Mortality, ischemic stroke, intracranial hemorrhage · median follow-up of 2.2 years — inappropriate low-dose apixaban vs appropriate full-dose apixaban · ischemic stroke · exploratory outcomes | 1.05 (0.90–1.23) | |
| Mortality, ischemic stroke, intracranial hemorrhage · median follow-up of 2.2 years — inappropriate low-dose apixaban vs appropriate full-dose apixaban · intracranial hemorrhage · exploratory outcomes | 0.95 (0.71–1.28) | |
| 0.512Adjusted hazard ratio (log scale) |
Unadjusted event rates (death, ischemic stroke, major bleeding) · median follow-up of 2.2 years
- Reduced-dose patients had higher unadjusted event rates than full-dose patients
- exploratory outcomes
Safety
| Outcome | adjusted HR (95% CI) | |
|---|---|---|
| Major bleeding · median follow-up of 2.2 years · exploratory outcome | 1.02 (0.89–1.17) | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
Clinical Patterns and Appropriateness of Apixaban Dosing in Patients With Atrial Fibrillation. JACC Adv. Published 29 June 2026. doi:10.1016/j.jacadv.2026.102954
Summarised from the published abstract; every number is checked against it