From the Guidelines
For new onset atrial fibrillation, the standard starting dose of apixaban is 5 mg taken orally twice daily, unless the patient has at least two of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, in which case the dose should be reduced to 2.5 mg twice daily. This recommendation is based on the most recent guidelines for the diagnosis and management of atrial fibrillation, as outlined in the 2023 ACC/AHA/ACCP/HRS guideline 1. The guideline provides a clear dosing strategy for apixaban, taking into account renal function and other patient characteristics.
Key Considerations
- The dose of apixaban should be adjusted based on renal function, with a reduced dose of 2.5 mg twice daily recommended for patients with severe renal impairment (creatinine clearance 15-29 mL/min) 1.
- Patients should be assessed for bleeding risk before initiating apixaban, and counseled about the importance of not missing doses and potential bleeding risks.
- Apixaban should be taken with or without food at approximately 12-hour intervals.
Patient Evaluation
Before starting apixaban, patients should undergo baseline renal and hepatic function assessment, as well as evaluation of their bleeding risk. This will help identify patients who may require dose adjustment or closer monitoring. The 2023 ACC/AHA/ACCP/HRS guideline provides a comprehensive framework for the management of atrial fibrillation, including recommendations for apixaban dosing 1.
From the FDA Drug Label
The recommended dose of apixaban tablets for most patients is 5 mg taken orally twice daily. The recommended dose of apixaban tablets is 2.5 mg twice daily in patients with at least two of the following characteristics: • age greater than or equal to 80 years • body weight less than or equal to 60 kg • serum creatinine greater than or equal to 1.5 mg/dL
The starting dose of apixaban in new onset atrial fibrillation is 5 mg taken orally twice daily for most patients, but may be 2.5 mg twice daily for patients with certain characteristics, such as age, weight, or serum creatinine levels 2.
From the Research
Apixaban Dosing in Atrial Fibrillation
- The standard dose of apixaban is 5 mg twice daily, but it can be reduced to 2.5 mg twice daily based on patient characteristics such as age, weight, and renal function 3, 4.
- Patients with at least two dose-reduction criteria (age 80 years or older, weight 60 kg or less, and creatinine level 1.5 mg/dL or higher) should receive the reduced dose of 2.5 mg twice daily 4.
- However, the study by 4 suggests that patients with only one dose-reduction criterion can still benefit from the standard dose of 5 mg twice daily.
- The starting dose of apixaban for new onset atrial fibrillation is not explicitly stated in the provided studies, but based on the information provided, it can be inferred that the standard dose of 5 mg twice daily is the typical starting dose, unless the patient meets the criteria for dose reduction.
Factors Affecting Apixaban Dosing
- Age, weight, and serum creatinine level are independent predictors of apixaban underdosage 3.
- Patients with advanced age, low body weight, or renal dysfunction have a higher risk of stroke or systemic embolism and major bleeding, but can still benefit from the standard dose of apixaban 4.