From the Research
No, a loading dose of Eliquis (apixaban) is not needed when transitioning a patient from intravenous unfractionated heparin (UFH) to apixaban. When switching from heparin infusion to apixaban, you should discontinue the heparin infusion and begin the standard apixaban dosing regimen (typically 5 mg twice daily, or 2.5 mg twice daily for patients meeting dose reduction criteria) at the time when the next dose of heparin would have been due. This approach ensures continuous anticoagulation while avoiding excessive anticoagulant effect. The rationale behind this recommendation is that unfractionated heparin has a very short half-life (approximately 60-90 minutes), so its anticoagulant effect diminishes quickly after discontinuation. Apixaban reaches therapeutic levels relatively quickly (with peak concentrations in 3-4 hours), which allows for a smooth transition without the need for a loading dose, as supported by the most recent study 1.
Some key points to consider when transitioning from heparin to apixaban include:
- The patient's renal function, as apixaban is renally cleared and dose adjustments may be necessary in patients with severe renal impairment 2
- The patient's weight and age, as these factors can affect apixaban dosing 1
- The risk of bleeding, as apixaban can increase the risk of bleeding, particularly in patients with renal impairment or those taking concomitant medications that increase the risk of bleeding 1
It's also important to note that the transition from heparin to apixaban should be done carefully, with close monitoring of the patient's anticoagulation status and adjustment of the apixaban dose as needed. However, based on the available evidence, a loading dose of apixaban is not necessary when transitioning from heparin infusion to apixaban, as the standard dosing regimen is sufficient to achieve therapeutic levels of anticoagulation.