From the Guidelines
Apixaban is typically dosed at 5 mg twice daily for most patients requiring anticoagulation, with a reduced dose of 2.5 mg twice daily recommended for patients meeting at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 mmol/L, as stated in the 2024 ESC guidelines for the management of atrial fibrillation 1. The dosing regimen for apixaban is crucial in preventing thromboembolic events while minimizing the risk of bleeding complications.
- The standard full dose of 5 mg twice daily is recommended for most patients, as it provides optimal prevention of thromboembolism related to atrial fibrillation.
- However, dose adjustments are necessary in certain populations, such as those with age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 mmol/L, who should receive a reduced dose of 2.5 mg twice daily.
- It is essential to note that the reduced dose is recommended only if at least two of the above criteria are met, as stated in the 2024 ESC guidelines 1.
- Additionally, the 2023 ACC/AHA/ACCp/HRS guideline for the diagnosis and management of atrial fibrillation also supports the use of apixaban at a dose of 5 mg or 2.5 mg twice daily, depending on the patient's renal function and other factors 1.
- The medication works by directly inhibiting factor Xa in the coagulation cascade, preventing thrombin formation and clot development, and does not require routine coagulation monitoring, making it more convenient for patients while still providing effective anticoagulation.
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 standard dosing regimen for apixaban in patients requiring anticoagulation is 5 mg taken orally twice daily for most patients. However, a reduced dose of 2.5 mg twice daily is recommended for patients with at least two of the following characteristics:
- age ≥ 80 years
- body weight ≤ 60 kg
- serum creatinine ≥ 1.5 mg/dL 2
From the Research
Apixaban Dosing Regimen
The standard dosing regimen for apixaban in patients requiring anticoagulation is as follows:
- For venous thromboembolism (VTE), apixaban is used at 10 mg twice daily for 7 days, followed by 5 mg twice daily without dose adjustment 3
- For non-valvular atrial fibrillation (NVAF), apixaban is used at 5 mg twice daily or 2.5 mg twice daily with dose adjustment criteria (DAC) including age, body weight, and renal function 3
Dose Adjustment Criteria
Dose adjustment criteria for apixaban in NVAF include:
- Age: 80 years or older
- Body weight: 60 kg or less
- Renal function: serum creatinine 1.5 mg/dL or greater 3 Patients who meet these criteria may require a reduced dose of 2.5 mg twice daily 3
Comparison of Dosing Regimens
A study comparing once-daily and twice-daily direct oral anticoagulants in NVAF found that once-daily regimens may lead to better adherence and persistence to therapy, but other studies have not found increased adherence among once-daily regimens 4 Apixaban is administered twice daily, whereas other direct oral anticoagulants such as edoxaban and rivaroxaban are administered once daily 4
Special Populations
In patients with end-stage renal disease on hemodialysis, apixaban dosing patterns vary, and deviations from manufacturer recommendations are common 5 A study found that 66.2% of patients receiving apixaban for treatment of acute or chronic thrombosis had deviations in recommended dosing, highlighting the need for prospective studies and updated dosing guidance in this population 5
Anticoagulation Therapy
Apixaban is a direct oral anticoagulant that directly inhibits factor Xa, providing more immediate anticoagulation compared to vitamin K antagonists 6 Anticoagulation therapy is recommended for preventing, treating, and reducing the recurrence of VTE, and preventing stroke in persons with atrial fibrillation 6