From the Guidelines
The recommended dose of Eloquis (Apixaban) for patients requiring anticoagulation is 5 mg taken orally twice daily, with a reduced dose of 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 ≥133 mmol/L. This recommendation is based on the most recent guidelines from the European Heart Journal 1. The dose adjustments are necessary to balance the risk of thromboembolism and bleeding in certain patient populations.
Key Considerations
- The standard full dose of 5 mg twice daily should be used to provide optimal prevention of thromboembolism related to atrial fibrillation, unless the patient meets the criteria for dose reduction.
- Patients with severe renal impairment may require dose adjustments, but the specific criteria for dose reduction in these patients are based on the presence of other risk factors, such as age and body weight.
- The medication should be taken consistently at approximately 12-hour intervals with or without food, and patients should not stop taking it without consulting their healthcare provider due to increased risk of stroke or blood clots.
Supporting Evidence
The European Heart Journal guidelines 1 provide the most up-to-date recommendations for the use of direct oral anticoagulants, including apixaban, in patients with atrial fibrillation. The guidelines emphasize the importance of individualizing treatment based on patient-specific factors, such as age, body weight, and renal function.
Clinical Implications
The recommended dose of apixaban should be adjusted based on the patient's individual risk factors, and the medication should be taken consistently to minimize the risk of thromboembolism and bleeding. Healthcare providers should carefully evaluate each patient's needs and adjust the dose accordingly, using the guidelines as a reference point. Additionally, the guidelines from the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines 1 support the use of apixaban in patients with atrial fibrillation, with similar recommendations for dose adjustments.
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.
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 dose of Eloquis (Apixaban) for patients requiring anticoagulation varies based on the specific indication:
- Nonvalvular Atrial Fibrillation: 5 mg twice daily (or 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)
- Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery: 2.5 mg twice daily
- Treatment of DVT and PE: 10 mg twice daily for the first 7 days, then 5 mg twice daily
- Reduction in the Risk of Recurrence of DVT and PE: 2.5 mg twice daily after at least 6 months of treatment for DVT or PE 2
From the Research
Recommended Dose of Eloquis (Apixaban)
The recommended dose of Eloquis (Apixaban) for patients requiring anticoagulation varies depending on the patient's condition and characteristics.
- For patients with atrial fibrillation, the standard dose is 5 mg twice daily, but dose reductions are recommended for patients with advanced age (≥80 years), low weight (≤60 kg), or elevated serum creatinine (≥1.5 mg/dL) 3, 4.
- Patients with at least two of these dose-reduction criteria should receive a reduced dose of 2.5 mg twice daily 4.
- For patients with acute venous thromboembolism, apixaban dose reductions due to renal dysfunction are not recommended 3.
- Low-dose apixaban (2.5 mg twice daily) may be effective and safe for secondary prophylaxis of venous thromboembolism in patients at high risk of recurrence 5.
Patient Characteristics and Dose Selection
When selecting a dose of apixaban, healthcare providers should consider the patient's individual characteristics, such as:
- Age: Advanced age (≥80 years) is a dose-reduction criterion 4.
- Weight: Low weight (≤60 kg) is a dose-reduction criterion 4.
- Renal function: Elevated serum creatinine (≥1.5 mg/dL) is a dose-reduction criterion 4.
- History of bleeding or embolism: Patients with a high risk of embolism and a low risk of bleeding may be suitable for dabigatran 150 mg twice daily, while most other patients may be suitable for apixaban 5 mg twice daily 6.
Adherence and Persistence
Adherence and persistence to apixaban treatment are important for effective anticoagulation.