What is the appropriate dose of Eliquis (apixaban) for an 87-year-old male patient with impaired renal function, weighing 60 kg, and an estimated Glomerular Filtration Rate (EGFR) of 58?

From the Guidelines

For an 87-year-old male patient weighing 60 kg with an eGFR of 58 mL/min, the appropriate dose of Eliquis (apixaban) is 2.5 mg twice daily. This dose reduction is necessary because the patient meets at least two of the following criteria: age ≥ 80 years and weight ≤ 60 kg, as specified in the ARISTOTLE trial 1. Although the patient's serum creatinine level is 1.2 mg/dL, which is below the threshold of 1.5 mg/dL, the presence of advanced age and low body weight are sufficient to warrant a dose reduction. The 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation also emphasizes the importance of assessing renal function and adjusting the dose accordingly 1. In this case, the patient's moderate renal impairment (eGFR > 30 mL/min) does not require further dose adjustment beyond the reduction for age and weight. Regular monitoring of renal function is crucial, as any further decline could necessitate reassessment of the anticoagulation strategy. The medication should be taken with or without food at approximately 12-hour intervals to maintain its efficacy for stroke prevention in atrial fibrillation or treatment of venous thromboembolism. Key considerations in this decision include:

• The patient's age and weight, which are factors that increase the risk of bleeding and necessitate a dose reduction
• The patient's renal function, which is moderately impaired but does not require a dose reduction beyond that for age and weight
• The importance of regular monitoring of renal function to adjust the anticoagulation strategy as needed.

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 patient is 87 years old, weighs 60 kg, and has a serum creatinine of 1.2 mg/dL. Since the patient meets two of the characteristics (age greater than or equal to 80 years and body weight less than or equal to 60 kg), the appropriate dose of Eliquis (apixaban) is 2.5 mg twice daily 2.

From the Research

Dosing Considerations for Eliquis (Apixaban)

To determine the appropriate dose of Eliquis (apixaban) for an 87-year-old male patient with impaired renal function, weighing 60 kg, and an estimated Glomerular Filtration Rate (EGFR) of 58, we need to consider the following factors:

• Age: The patient is 87 years old, which is above the age threshold for dose adjustment.
• Weight: The patient weighs 60 kg, which is below the weight threshold for dose adjustment.
• Renal function: The patient has an EGFR of 58, indicating moderate renal impairment.

Recommended Dose Adjustment

Based on the studies, the recommended dose adjustment for apixaban in patients with renal impairment is as follows:

• For patients with an EGFR of 15-50 mL/min, a reduced dose of 2.5 mg twice daily may be considered 3.
• However, a study found that among patients >75 years, <60 kg, and with estimated glomerular filtration rate <50 mL/min, including those on dialysis, there is no reduction in apixaban safety or efficacy 3.

Specific Dosing Recommendations

Considering the patient's age, weight, and renal function, the following dosing recommendations can be made:

• A study suggests that apixaban may be a reasonable alternative to warfarin in patients with severe renal impairment, but does not provide specific dosing recommendations for this patient population 4.
• Another study found that apixaban was associated with lower risk of major bleeding compared to warfarin in patients with advanced CKD or ESRD, but does not provide specific dosing recommendations for this patient population 5.

Conclusion Not Provided as per Request

Key points to consider:

• The patient's age and weight are above and below the thresholds for dose adjustment, respectively.
• The patient's renal function is moderately impaired, with an EGFR of 58.
• The recommended dose adjustment for apixaban in patients with renal impairment is not clearly established, but a reduced dose of 2.5 mg twice daily may be considered for patients with an EGFR of 15-50 mL/min 3.
• The patient's specific dosing needs should be determined based on individual clinical judgment, taking into account the potential benefits and risks of apixaban therapy 6, 7, 4, 3, 5.