From the Guidelines
The recommended dosing for Eliquis (apixaban) in patients requiring anticoagulation is 5 mg taken orally twice daily, with a reduced dose of 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, as supported by the most recent guidelines 1.
Key Considerations
- Apixaban is a direct factor Xa inhibitor that prevents thrombin formation and clot development, providing effective anticoagulation with a more predictable response and fewer food-drug interactions than warfarin.
- The dosing recommendations are based on the patient's renal function, with dose adjustments necessary for patients with severe renal impairment.
- The guidelines recommend assessing renal function before initiating therapy and adjusting the dose accordingly.
Indications and Dosage
- For most patients with atrial fibrillation, the standard dose is 5 mg taken orally 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, a reduced dose of 2.5 mg twice daily is recommended.
- For treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE), the initial dose is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months.
- For DVT/PE prophylaxis following hip or knee replacement surgery, the recommended dose is 2.5 mg twice daily, starting 12-24 hours after surgery and continuing for 35 days (hip) or 12 days (knee).
Important Safety Information
- Apixaban should be taken with or without food at approximately the same times each day to maintain consistent blood levels.
- Renal function should be assessed before initiating therapy as dose adjustments may be necessary for patients with severe renal impairment.
- The guidelines recommend avoiding apixaban in patients with severe renal impairment (CrCl <15 mL/min) or hepatic impairment (patients with transaminases >2 times the upper limit of normal or total bilirubin >1.5 times the upper limit of normal) 1.
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. The initial dose should be taken 12 to 24 hours after surgery. • In patients undergoing hip replacement surgery, the recommended duration of treatment is 35 days. • In patients undergoing knee replacement surgery, the recommended duration of treatment is 12 days 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 dosing for Eliquis (apixaban) in patients requiring anticoagulation varies based on the indication and patient characteristics.
- For nonvalvular atrial fibrillation, the dose is 5 mg twice daily for most patients, but 2.5 mg twice daily for those with at least two of the following: age ≥ 80 years, body weight ≤ 60 kg, or serum creatinine ≥ 1.5 mg/dL.
- For prophylaxis of deep vein thrombosis following hip or knee replacement surgery, the dose is 2.5 mg twice daily, starting 12 to 24 hours after surgery.
- For treatment of DVT and PE, the dose is 10 mg twice daily for the first 7 days, then 5 mg twice daily.
- For reduction in the risk of recurrence of DVT and PE, the dose is 2.5 mg twice daily after at least 6 months of treatment 2.
From the Research
Recommended Dosing for Eliquis (Apixaban)
The recommended dosing for Eliquis (apixaban) in patients requiring anticoagulation varies depending on the patient's condition and renal function.
- For patients with nonvalvular atrial fibrillation, the recommended dose is 5 mg twice daily 3.
- For patients with venous thromboembolism, the recommended dose is 10 mg twice daily for 7 days, followed by 5 mg twice daily 3.
- For patients with severe renal impairment, the dosing of apixaban is not well established, but studies suggest that a reduced dose of 2.5 mg twice daily may be used 4, 5.
- However, a study published in 2018 found that a standard dose of 5 mg twice daily was associated with lower risks of stroke, systemic embolism, and death compared to a reduced dose of 2.5 mg twice daily or warfarin in patients with end-stage kidney disease and atrial fibrillation 6.
Considerations for Patients with Renal Impairment
- Patients with advanced chronic kidney disease (CrCl 25-30 mL/min) may require a reduced dose of apixaban, but the optimal dose is not well established 7, 4.
- A study published in 2021 found that there was no difference in major bleeding events or any bleeding events between patients with chronic kidney disease stage 4 and 5 who received apixaban 5 mg twice daily or 2.5 mg twice daily 4.
- Another study published in 2025 found that apixaban was associated with a significantly reduced incidence of anticoagulation-related emergency department admissions compared to warfarin in patients with severe renal impairment 5.
Key Findings
- Apixaban has been shown to be effective and safe in patients with atrial fibrillation and advanced chronic kidney disease, with a lower risk of major bleeding compared to warfarin 7, 6.
- The optimal dosing of apixaban in patients with severe renal impairment is not well established, but studies suggest that a standard dose of 5 mg twice daily may be associated with lower risks of stroke, systemic embolism, and death 6.
- Further studies are needed to determine the optimal dosing of apixaban in patients with renal impairment 7, 4, 5.