From the Guidelines
Eliquis (apixaban) is the preferred medication for stroke prevention in atrial fibrillation due to its efficacy and safety profile, as demonstrated in the most recent guidelines 1. The standard dosing is 5 mg twice daily for most patients. However, dose reduction to 2.5 mg twice daily is recommended if the patient has at least two of the following: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, as indicated in the 2023 ACC/AHA/ACCP/HRS guideline 1. Some key points to consider when prescribing Eliquis include:
- Assessing renal function, as dose adjustments are necessary for patients with severe renal impairment (creatinine clearance 15-29 mL/min) 1
- Evaluating liver function and bleeding risk, as these factors can impact the safety of Eliquis 1
- Counseling patients on the importance of consistent dosing, approximately 12-hour intervals, with or without food, and the risks of bleeding 1 Other DOACs, such as rivaroxaban or dabigatran, may be considered for patients with specific comorbidities, compliance concerns, or cost considerations, but apixaban is generally the preferred choice due to its favorable safety and efficacy profile, as demonstrated in studies such as ARISTOTLE 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 dose of Eliquis (apixaban) for a patient with Atrial Fibrillation (A fib) is 5 mg orally twice daily for most patients. However, for patients with at least two of the following characteristics: age ≥ 80 years, body weight ≤ 60 kg, or serum creatinine ≥ 1.5 mg/dL, the recommended dose is 2.5 mg orally twice daily 2.
From the Research
Eliquis (Apixaban) for Atrial Fibrillation
- Eliquis (apixaban) is a commonly used medication for stroke prevention in patients with atrial fibrillation (A fib) 3, 4, 5, 6.
- The standard dose of apixaban is 5 mg twice daily, but patients with certain characteristics (e.g., advanced age, low body weight, or renal dysfunction) may require a reduced dose of 2.5 mg twice daily 3.
Comparison with Other Medications
- Studies have compared the effectiveness and safety of apixaban with other oral anticoagulants, such as dabigatran and rivaroxaban 5, 6.
- Apixaban has been shown to have a lower risk of major bleeding compared to dabigatran and rivaroxaban 5, 6.
- A practical guide has been proposed to choose between dabigatran and apixaban for patients with A fib, recommending apixaban for most patients due to its lower bleeding risk 4.
Dosing Considerations
- The dose of apixaban should be individualized based on patient characteristics, such as age, body weight, and renal function 3.
- Patients with one or no dose-reduction criteria can be safely treated with the standard dose of 5 mg twice daily 3.
- Patients with end-stage renal disease or receiving dialysis may require careful consideration of the risks and benefits of apixaban versus other oral anticoagulants, such as rivaroxaban 7.
Key Findings
- Apixaban has been shown to be effective and safe for stroke prevention in patients with A fib, with a lower risk of major bleeding compared to other oral anticoagulants 5, 6.
- The standard dose of apixaban is 5 mg twice daily, but patients with certain characteristics may require a reduced dose 3.
- A practical guide can be used to choose between apixaban and other oral anticoagulants for patients with A fib 4.