{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:49:37Z","timestamp":1777420177483,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T00:00:00Z","timestamp":1694736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Apixaban is commonly used to prevent stroke in older adults with nonvalvular atrial fibrillation (AF). Although its package insert has specific dose reduction criteria, providers may dose reduce outside of these parameters based on clinical scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The primary objective was to determine the incidence of apixaban off-label reduced dosing, while secondarily determining the safety and efficacy outcomes associated with such dosing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective analysis of patients aged 65 and older with orders for apixaban for AF was institutional review board (IRB)-approved and conducted across 3 academic medical centers. Patients receiving off-label reduced-dose apixaban (ie, \u201cunderdosed\u201d) were matched to a cohort of patients dosed according to the package insert at the standard dosing (5 mg twice daily) using stratified random sampling. Secondary outcomes included 1-year incidence of major bleeding, clinically relevant non-major bleeding (CRNMB), stroke or transient ischemic attack (TIA), and mortality. The Fisher exact tests were used to compare between-group differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of the 1172 patients meeting initial inclusion criteria, 201 (17%) were dosed off-label, with 175 (15%) \u201cunderdosed.\u201d The 147 \u201cunderdosed\u201d patients with documented follow-up were matched with 139 patients receiving standard Food and Drug Administration (FDA)-labeled dosing. There were no significant differences in incidence of stroke (2.7% vs 2.2%), major bleeding (0% vs 0.7%), and CRNMB (2.7% vs 1.4%) in the off-label reduced dosing versus standard dosing groups. All-cause mortality was higher in the off-label reduced-dose group (16 [10.9%] vs 2 [1.4%], P &lt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and Relevance:<\/jats:title>\n                    <jats:p>Older adults with nonvalvular AF are commonly prescribed lower-than-recommended doses of apixaban. However, no significant association was found between empiric off-label reduced dosing and stroke or bleeding outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10600280231199137","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T07:26:41Z","timestamp":1694762801000},"page":"572-580","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Off-Label Reduced Dose Apixaban in Older Adults With Atrial Fibrillation and Associated Outcomes"],"prefix":"10.1177","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7110-8287","authenticated-orcid":false,"given":"Ashley M.","family":"Campbell","sequence":"first","affiliation":[{"name":"R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA"},{"name":"Department of Pharmacy, Banner\u2014University Medical Center Tucson, Tucson, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Pae","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Banner\u2014University Medical Center Tucson, Tucson, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunice","family":"Lee","sequence":"additional","affiliation":[{"name":"Kaiser Permanente, Union City, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Jacisin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Cooperman Barnabas Medical Center, Livingston, NJ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alina","family":"Price","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Banner\u2014University Medical Center Tucson, Tucson, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"DeAngelo","sequence":"additional","affiliation":[{"name":"R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA"},{"name":"Department of Pharmacy, Banner\u2014University Medical Center Tucson, Tucson, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,9,15]]},"reference":[{"key":"bibr1-10600280231199137","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.01.011"},{"key":"bibr2-10600280231199137","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"bibr3-10600280231199137","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18372"},{"key":"bibr4-10600280231199137","unstructured":"Eliquis (apixaban) [package insert]. DailyMed. Published online September 30, 2021. 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