Dosing considerations in the use of the direct oral anticoagulants in the antiphospholipid syndrome.
What is known and objectives At least four prospective trials have been initiated investigating the direct oral anticoagulants in the antiphospholipid syndrome. Preliminary reports have supported their use in patients with a history of venous thrombosis and a target INR of 2-3, but there have also b...
| Publicado en: | Journal of Clinical Pharmacy & Therapeutics Vol. 43; no. 1; pp. 104 - 107 |
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| Autores principales: | , |
| Formato: | case study Journal Article |
| Publicado: |
Wiley-Blackwell
Feb2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=127063644&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 127063644 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02694727 EV4 jtl: Journal of Clinical Pharmacy & Therapeutics issn: 02694727 maglogo: Y pubinfo: dt: Feb2018 vid: 43 iid: 1 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 127063644 127063644 127063644 10.1111/jcpt.12582 127063644 ppf: 104 ppct: 3 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Dosing considerations in the use of the direct oral anticoagulants in the antiphospholipid syndrome. aug: au: Schofield, J. R. Hassell, K. affil: University of Colorado at Denver ‐ Anschutz Medical Campus, Aurora, CO, USA sug: subj: Anticoagulants Administration and Dosage Administration, Oral Antiphospholipid Syndrome Drug Therapy Anticoagulants Pharmacokinetics Adverse Drug Event Human Female Middle Age Pyoderma Gangrenosum Middle Aged: 45-64 years Female ab: What is known and objectives At least four prospective trials have been initiated investigating the direct oral anticoagulants in the antiphospholipid syndrome. Preliminary reports have supported their use in patients with a history of venous thrombosis and a target INR of 2-3, but there have also been reports of failure of these agents in the antiphospholipid syndrome. The objective is to present a case report that illustrates there may be important dosing issues when considering the use of these agents in patients with the antiphospholipid syndrome. Case summary A 50-year-old woman with the antiphospholipid syndrome, manifesting clinically with recurrent pyoderma gangrenosum-like leg ulcers, was treated with apixaban, resulting in improved ulcer healing. For insurance purposes, she was switched to rivaroxaban with worsening of the ulcers which again improved when apixaban was resumed. What is new and conclusion Despite a similar half-life, pharmacokinetics and pharmacodynamics, the manufacturer-recommended maintenance dosing of apixaban is twice daily and rivaroxaban once daily. We believe this difference in recommended dose accounts for the differential clinical response noted in the present case report and that twice daily dosing and a larger daily dose of these agents may be more efficacious in potent hypercoagulable disorders, such as the antiphospholipid syndrome. pubtype: Academic Journal doctype: case study Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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