ArticleThe Journal of frailty & aging2026
Fat-free mass index and apixaban exposure in frail hospitalized older adults: An exploratory study.
Article in The Journal of frailty & aging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundReduced muscle mass may influence creatinine-based renal estimates and direct oral anticoagulant exposure in frail older adults.
objectivesTo explore the relationship between fat-free mass index (FFMI) and apixaban trough concentrations in hospitalized older adults.
methodsIn this retrospective study, FFMI was assessed by bioelectrical impedance analysis in patients aged ≥75 years treated with apixaban. FFMI was considered a body-composition marker, not a diagnostic criterion for sarcopenia.
resultsAmong 305 screened patients, 43 receiving apixaban 5 mg twice daily with compliant trough sampling were included. Mean age was 83.6 ± 5.8 years. FFMI correlated inversely with apixaban concentrations in the unadjusted analysis (Spearman's ρ = -0.34, p = 0.024). In univariable linear regression, lower FFMI was associated with higher apixaban concentrations (β = -8.64 ng/mL per kg/m², 95% CI -16.15 to -1.13; p = 0.025), but this association was not confirmed after adjustment for sex and serum creatinine (adjusted β = -6.77, 95% CI -15.20 to 1.65; p = 0.112) or in the sensitivity analysis including both dose groups (n = 82; ρ = -0.06, p = 0.575). Body weight, BMI, and creatinine-based renal estimates were not significantly associated with apixaban concentrations.
conclusionsAn inverse relationship between FFMI and apixaban trough concentrations was observed in the unadjusted primary analysis but was not confirmed after multivariable adjustment or in the sensitivity analysis. This preliminary signal should be considered hypothesis-generating and requires confirmation in larger prospective studies.
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