Evaluation of standard versus reduced dose apixaban for the treatment of venous thromboembolism in patients with severe renal disease (ESRD-VTE).

BACKGROUND: There are no clear dosing recommendations when using apixaban for venous thromboembolism (VTE) treatment in patients with severe or end-stage renal disease; clinical trials excluded patients with a creatinine clearance (CrCl) <25 mL/min or on dialysis. This study compares bleeding rates in patients with severe or end-stage renal disease taking standard versus reduced dose apixaban for VTE treatment. MATERIALS AND METHODS: This was a multicenter, retrospective cohort study using electronic medical records between January 1, 2013, and August 31, 2021. This study included patients 18 years or older who had severe or end-stage renal disease when prescribed apixaban for VTE treatment. Severe or end-stage renal disease was defined as at least one of the following: CrCl <25 mL/min, SCr >2.5 mg/dL, CKD stage 4 or 5, or on dialysis. The primary endpoint was rate of clinically relevant bleeding within six months of starting apixaban. Secondary endpoints were VTE recurrence within six months of starting apixaban, time to clinically relevant bleed, and time to VTE recurrence. RESULTS: A total of 203 patients were included in the final analysis (n = 125 on 5 mg; n = 78 on 2.5 mg). Clinically relevant bleeding rate was significantly higher in the standard dose group (14.4 % vs 3.8 %, p = 0.02). Rates of VTE recurrence appear similar (6.4 % vs 7.7 %, p = 0.21). CONCLUSIONS: A reduced dose of apixaban may be considered when treating VTE in patients with severe or end-stage renal disease.

The impact of the pharmacist on continuity of care during transitions of care: A systematic review.

OBJECTIVES: To evaluate programs that provide pharmacy-led continuity of care services and to assess their effectiveness in improving patient outcomes. DATA SOURCES: Three databases were used to conduct the article search and assess relevant articles: PubMed (Medline), Cinahl, and Web of Science. STUDY SELECTION: Articles that included prospective measurement with defined clinical outcomes of the impact of including a pharmacist in discharge planning and continuity of care after a hospitalization were included in the review. Articles were limited to those available in English, conducted within the United States, and including humans. DATA EXTRACTION: Relevant articles from the full database collections through April 2017. RESULTS: Readmission rates were the most common primary outcome evaluated. Other primary outcomes included medication adherence, medication error identification and reduction, and patient satisfaction. Although the data has shown that pharmacists play a crucial role by promoting medication adherence and providing effective medication reconciliation, this systematic review did not result in identifying any one pharmacist intervention to be the most effective in improving continuity of care. CONCLUSION: There is both a need and an opportunity for research that supports best practices in providing continuity of care during transitions of care.