Canadian Journal of Cardiology
Case Report| Volume 34, ISSUE 3, P342.e17-342.e19, March 2018

Personalized Anticoagulation: Guided Apixaban Dose Adjustment to Compensate for Pharmacokinetic Abnormalities Related to Short-Bowel Syndrome

Published:December 27, 2017DOI:


      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.


      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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