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Hepatic clearance accounts for roughly 25% of total apixaban elimination, primarily through CYP3A4 with minor contributions from CYP1A2, CYP2C8, CYP2C9, CYP2C19, and CYP2J2 [2]

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The vascular origin of these changes also clarifies the incomplete response to prokinetic or antibiotic therapy, which cannot reverse microcirculatory failure [30]