What is the recommended dosage of Apixaban (Apixaban) for patients with atrial fibrillation or deep vein thrombosis/pulmonary embolism, considering factors such as age, body weight, and impaired renal function?

From the Guidelines

The recommended dosage of apixaban for most patients with atrial fibrillation is 5 mg taken orally twice daily, but it should be reduced to 2.5 mg twice daily if the patient meets at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, as stated in the 2023 ACC/AHA/ACCP/HRS guideline 1.

Key Considerations for Apixaban Dosage

• For patients with atrial fibrillation, the dosage remains 5 mg twice daily unless specific criteria for dose reduction are met, such as age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, in which case the dose is reduced to 2.5 mg twice daily 1.
• The dosage for deep vein thrombosis (DVT) or pulmonary embolism (PE) typically starts with 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months, but the provided guidelines do not specifically address the DVT/PE dosing adjustments based on renal function or other factors beyond atrial fibrillation 1.
• Patients with severe renal impairment (creatinine clearance 15-29 mL/min) should receive 2.5 mg twice daily for atrial fibrillation, but the guidelines do not recommend apixaban for those with creatinine clearance below 15 mL/min or on dialysis 1.

Administration and Monitoring

• Apixaban should be taken with or without food at approximately the same times each day to maintain consistent blood levels.
• The dose adjustments are necessary because apixaban is partially eliminated by the kidneys, and factors like advanced age, low body weight, and impaired renal function can increase drug exposure and bleeding risk, as highlighted in both the 2023 ACC/AHA/ACCP/HRS guideline 1 and the 2018 European Heart Rhythm Association practical guide 1.

Clinical Decision Making

• When deciding on the apixaban dosage, clinicians must consider not only the patient's renal function but also their age and body weight to minimize the risk of bleeding while effectively preventing thromboembolic events.
• The most recent guideline from 2023 1 provides clear recommendations for dose adjustments based on these factors, emphasizing the importance of personalized treatment plans in the management of atrial fibrillation and other conditions where apixaban is indicated.

From the FDA Drug Label

2.1 Recommended Dose Reduction of Risk of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation 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

Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily.

Treatment of DVT and PE The recommended dose of apixaban tablets is 10 mg taken orally twice daily for the first 7 days of therapy. After 7 days, the recommended dose is 5 mg taken orally twice daily.

Reduction in the Risk of Recurrence of DVT and PE The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily after at least 6 months of treatment for DVT or PE

The recommended dosage of Apixaban for patients with atrial fibrillation is 5 mg twice daily for most patients, but 2.5 mg twice daily for patients with at least two of the following characteristics:

• age ≥ 80 years
• body weight ≤ 60 kg
• serum creatinine ≥ 1.5 mg/dL For patients with deep vein thrombosis/pulmonary embolism, the recommended dosage is 10 mg twice daily for the first 7 days, then 5 mg twice daily. For the reduction in the risk of recurrence of DVT and PE, the recommended dosage is 2.5 mg twice daily after at least 6 months of treatment. 2

From the Research

Apixaban Dosage for Atrial Fibrillation and Deep Vein Thrombosis/Pulmonary Embolism

The recommended dosage of Apixaban for patients with atrial fibrillation or deep vein thrombosis/pulmonary embolism varies based on factors such as age, body weight, and impaired renal function.

• For patients with atrial fibrillation, the standard dose is 5 mg twice daily 3.
• For patients with deep vein thrombosis/pulmonary embolism, a fixed-dose regimen of 5 mg twice daily is effective and associated with a reduced risk of major bleeding 4.
• Extended anticoagulation with Apixaban at either a treatment dose (5 mg twice daily) or thromboprophylactic dose (2.5 mg twice daily) reduces the risk of recurrent venous thromboembolism without increasing the rate of major bleeding 4.

Considerations for Special Populations

• Age: No specific dosage adjustments are recommended based on age alone 3.
• Body weight: No specific dosage adjustments are recommended based on body weight alone 4.
• Impaired renal function: Caution is required when using Apixaban in patients with impaired renal function, as it may increase the risk of bleeding 5.

Comparison with Other Anticoagulants

• Apixaban has been shown to be as effective as warfarin and other non-vitamin K antagonist oral anticoagulants (NOACs) in reducing thromboembolic events and stroke, with a lower risk of major bleeding 3.
• The risk of gastrointestinal bleeding is lower with Apixaban compared to other oral anticoagulant agents 3.