From the Guidelines
The recommended dose of apixaban for anticoagulation is typically 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, as supported by the most recent guidelines 1.
Key Considerations for Apixaban Dosing
- For patients with atrial fibrillation, the standard 5 mg twice daily dosing is used for stroke prevention.
- For treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE), the initial dosing is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily, as indicated in the 2020 ACC expert consensus decision pathway 1.
- Dose reduction is also indicated for patients with severe renal impairment (creatinine clearance 15-29 mL/min).
- Apixaban works by directly inhibiting factor Xa in the coagulation cascade, preventing thrombin formation and clot development, and has a predictable anticoagulant effect that doesn't require routine monitoring like warfarin does, with a relatively favorable bleeding risk profile compared to some other anticoagulants, as noted in the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1.
Important Evidence
- The ARISTOTLE trial demonstrated the efficacy and safety of apixaban compared to warfarin in patients with atrial fibrillation, with a significant reduction in stroke, systemic embolism, and major bleeding events 1.
- The 2020 ACC expert consensus decision pathway provides guidance on anticoagulation dosing for patients with atrial fibrillation or venous thromboembolism undergoing percutaneous coronary intervention or with atherosclerotic cardiovascular disease, including recommendations for apixaban dosing 1.
Clinical Implications
- Apixaban is a valuable option for anticoagulation in patients with atrial fibrillation or venous thromboembolism, offering a predictable anticoagulant effect and a relatively favorable bleeding risk profile.
- Clinicians should carefully consider patient-specific factors, including age, weight, and renal function, when determining the appropriate dose of apixaban, as recommended 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
The recommended anticoagulation dose of apixaban is 5 mg twice daily for most patients, but it can be reduced to 2.5 mg twice daily in certain patients with specific characteristics, such as age ≥ 80 years, body weight ≤ 60 kg, or serum creatinine ≥ 1.5 mg/dL 2.
- Key considerations:
- Dose reduction: Patients with at least two of the specified characteristics should receive a reduced dose of 2.5 mg twice daily.
- Standard dose: Most patients should receive the standard dose of 5 mg twice daily.
- Renal function: Serum creatinine levels should be considered when determining the appropriate dose.
From the Research
Anticoagulation Dose of Apixaban
The recommended dose of apixaban for anticoagulation varies depending on the patient's condition and other factors.
- For patients with acute venous thromboembolism, the dose is 10 mg twice daily for 7 days, followed by 5 mg twice daily for 6 months 3.
- For patients with cancer-associated venous thromboembolism, the dose is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily 4.
- For patients with nonvalvular atrial fibrillation, the dose is 5 mg twice daily, with a reduced dose of 2.5 mg twice daily for patients with certain characteristics, such as age, weight, or kidney function 5, 6, 7.
Factors Affecting Apixaban Dose
Several factors can affect the dose of apixaban, including:
- Age: Older adults may require lower doses due to decreased kidney function and increased risk of bleeding 7.
- Weight: Patients with lower body weight may require lower doses 6.
- Kidney function: Patients with decreased kidney function may require lower doses 5, 6.
- Concomitant medications: Certain medications, such as antiplatelet agents or other anticoagulants, may interact with apixaban and affect its dose 5.
Monitoring Apixaban Concentrations
Monitoring apixaban concentrations may be necessary in certain patients, such as those with kidney disease or those taking concomitant medications that interact with apixaban 6, 7.