Abstract
A 45-year-old woman who required lifelong anticoagulation for recurrent thrombosis
had her therapeutic choices limited by heparin-induced thrombocytopenia and abnormal
pharmacokinetics (greatly reduced absorption) resulting from short gut syndrome from
extensive gut resection after mesenteric thrombosis. As an alternative to inconvenient
and expensive injections of fondaparinux, personalized dosing of a direct oral anticoagulant
was sought using clinical pharmacology techniques. Enteral absorption was ascertained
with small test doses of apixaban, and the ability of supraconventional doses to deliver
effective concentrations was verified.
Résumé
Une femme de 45 ans ayant besoin d’une anticoagulothérapie à vie pour une thrombose
récurrente a vu ses options thérapeutiques limitées par une thrombocytopénie induite
par l’héparine et une pharmacocinétique anormale (absorption grandement réduite) liée
à un syndrome de chasse intestinale résultant d’une résection d’une partie importante
de l’intestin après une thrombose mésentérique. Comme solution de rechange aux injections
chères et peu pratiques de fondaparinux, l’administration personnalisée d’un anticoagulant
oral direct a été tentée à l’aide de techniques de pharmacologie clinique. L’absorption
entérale a été établie grâce à de petites doses expérimentales d’apixaban, et la capacité
des doses supra-conventionnelles à procurer des concentrations efficaces a été vérifiée.
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References
- The receptor concept: pharmacology's big idea.Br J Pharmacol. 2006; 147: S9-S16
- ELIQUIS (apixaban) product monograph, 2017.(Available at:)http://www.pfizer.ca/sites/g/files/g10037206/f/201710/ELIQUIS_PM_184464_16June2016_E_marketed.pdfDate accessed: October 20, 2017
- Importance of pharmacokinetic profile and variability as determinants of dose and response to dabigatran, rivaroxaban, and apixaban.Can J Cardiol. 2013; 29: S24-33
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Article info
Publication history
Published online: December 27, 2017
Accepted:
December 20,
2017
Received:
October 25,
2017
Footnotes
See page 342.e19 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
