From the Guidelines
The recommended dosing for Eliquis (apixaban) in patients with atrial fibrillation is 5 mg taken orally twice daily, with a reduced dose of 2.5 mg twice daily recommended for patients who meet at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. This recommendation is based on the most recent and highest quality study, which is the 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation 1. The dosing recommendations for apixaban are as follows:
- 5 mg twice daily for patients with normal renal function
- 2.5 mg twice daily for patients who meet at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL
- 5 mg twice daily for patients with severe renal impairment (creatinine clearance 15-29 mL/min), but this should be used with caution and careful monitoring of renal function. It's also important to note that apixaban should be taken with or without food at approximately 12-hour intervals for consistent anticoagulation effect. When transitioning from warfarin to Eliquis, discontinue warfarin and start Eliquis when the INR is below 2.0. Patients should not discontinue Eliquis without consulting their healthcare provider due to increased stroke risk. If a dose is missed, it should be taken as soon as possible on the same day, then resume the normal twice-daily schedule. Eliquis works by inhibiting Factor Xa, preventing thrombin formation and clot development, which reduces the risk of stroke and systemic embolism in atrial fibrillation patients without significantly increasing major bleeding risk compared to traditional anticoagulants, as shown in the ARISTOTLE trial 2. The European Heart Rhythm Association also recommends apixaban as a first-line treatment for stroke prevention in atrial fibrillation, with a dose reduction for patients with severe renal impairment or those who meet certain criteria 3. Overall, the recommended dosing for Eliquis in patients with atrial fibrillation is based on the patient's renal function and other factors, and should be individualized to minimize the risk of stroke and bleeding complications.
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 recommended dosing for Eliquis (apixaban) in patients with atrial fibrillation (a fib) is 5 mg taken orally twice daily for most patients. However, for 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 recommended dose is 2.5 mg twice daily 4.
From the Research
Recommended Dosing for Eliquis (Apixaban) in Patients with Atrial Fibrillation
The recommended dosing for Eliquis (apixaban) in patients with atrial fibrillation (a fib) is as follows:
- The standard dose of apixaban is 5 mg twice daily 5
- Patients with at least 2 dose-reduction criteria (80 years or older, weight 60 kg or less, and creatinine level 1.5 mg/dL or higher) should receive a reduced dose of apixaban of 2.5 mg twice daily 5
- Patients with only 1 dose-reduction criterion can receive the standard dose of 5 mg twice daily, as it is safe and efficacious 5
Comparison with Other Anticoagulants
Apixaban has been compared to other anticoagulants, such as dabigatran and rivaroxaban, in terms of effectiveness and safety:
- Apixaban was associated with a lower risk of major bleeding compared to dabigatran and rivaroxaban 6, 7
- Apixaban was associated with a similar risk of stroke or systemic embolism compared to dabigatran and rivaroxaban 6, 7
- Low-dose apixaban (2.5 mg twice daily) was associated with a greater risk of stroke or systemic embolism and death compared to standard-dose apixaban (5 mg twice daily) 8
Key Points
- The standard dose of apixaban is 5 mg twice daily for patients with atrial fibrillation
- Patients with at least 2 dose-reduction criteria should receive a reduced dose of 2.5 mg twice daily
- Apixaban has a favorable bleeding risk profile compared to other anticoagulants
- Low-dose apixaban may be associated with a greater risk of stroke or systemic embolism and death compared to standard-dose apixaban 5, 6, 8, 7, 9