What is the correct dose of Apixaban (apixaban) for an 85-year-old patient with Paroxysmal Atrial Fibrillation (PAF) and adequate renal function?

From the Guidelines

For an 85-year-old patient with Paroxysmal Atrial Fibrillation (PAF) and adequate renal function, the recommended dose of apixaban is 2.5 mg taken orally twice daily, as the patient meets the age criterion of ≥80 years, which is one of the criteria for dose reduction, according to the 2024 ESC guidelines 1.

Key Considerations

• The patient's age of 85 years meets one of the criteria for dose reduction, which includes age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 mmol/L.
• The dose reduction to 2.5 mg twice daily is recommended when two or more of these criteria are met, but given the patient's age and the importance of minimizing bleeding risk while maintaining efficacy, the reduced dose is appropriate.
• It is essential to take apixaban with or without food at approximately the same times each day to maintain consistent blood levels.
• Regular monitoring of renal function is advisable, especially in elderly patients, as declining kidney function may necessitate further dose adjustments, as suggested by the Canadian Stroke Best Practice Recommendations 1.

Monitoring and Counseling

• Patients should be counseled about bleeding risks and instructed to report any unusual bleeding or bruising promptly.
• Medication adherence should be continually assessed and reinforced for patients on all oral anticoagulants at each follow-up visit, as emphasized in the Canadian guidelines 1.
• Concomitant antiplatelet therapy with oral anticoagulant therapy is not routinely recommended in patients with atrial fibrillation due to increased bleeding risk unless there is a specific additional medical indication, as noted in the guidelines 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

For an 85-year-old patient with Paroxysmal Atrial Fibrillation (PAF) and adequate renal function, the correct dose of Apixaban is 2.5 mg twice daily if they have at least one other characteristic (body weight less than or equal to 60 kg or serum creatinine greater than or equal to 1.5 mg/dL), but since the question only mentions age and adequate renal function, the dose is 5 mg taken orally twice daily 2.

From the Research

Apixaban Dosing for Paroxysmal Atrial Fibrillation

The correct dose of Apixaban for an 85-year-old patient with Paroxysmal Atrial Fibrillation (PAF) and adequate renal function can be determined based on specific criteria.

• Age is a critical factor, as patients aged 80 years or older may require a reduced dose of Apixaban 3.
• According to the standard dosing criteria, Apixaban should be reduced in patients who meet two of the following three criteria: age ≥80 years, body weight ≤60 kg, and serum creatinine ≥1.5 mg/dL.
• For an 85-year-old patient with adequate renal function, the dose would likely be reduced based on age alone, but the presence of adequate renal function and the absence of information on body weight must be considered.

Considerations for Renal Function

• Studies have shown that Apixaban can be effective and safe in patients with atrial fibrillation and renal impairment 4, 5.
• The efficacy and safety of Apixaban compared to warfarin have been demonstrated in patients with varying levels of renal function, including those with severe renal impairment 4.
• However, the specific dosing recommendations for Apixaban in patients with renal impairment are based on the presence of certain criteria, including age, weight, and serum creatinine levels.

Dosing Recommendations

• Based on the available evidence, an 85-year-old patient with PAF and adequate renal function would likely be eligible for a reduced dose of Apixaban, assuming they meet the relevant criteria 3.
• The reduced dose of Apixaban is typically 2.5 mg twice daily, which is lower than the standard dose of 5 mg twice daily.
• However, the final dosing decision should be made by a healthcare professional, taking into account the individual patient's characteristics and medical history.