What is the recommended dose of Eliquis (apixaban) for new onset atrial fibrillation?

Apixaban Dosing for New Onset Atrial Fibrillation

The recommended dose of apixaban (Eliquis) for most patients with new onset atrial fibrillation is 5 mg taken orally twice daily. 1, 2

Standard Dosing vs. Reduced Dosing

Standard Dosing

• 5 mg orally twice daily for most patients with nonvalvular atrial fibrillation 1, 2

Reduced Dosing Criteria

The dose should be reduced to 2.5 mg twice daily if the patient has at least two of the following characteristics:

• Age ≥80 years
• Body weight ≤60 kg
• Serum creatinine ≥1.5 mg/dL 1, 2, 3

Renal Function Considerations

Apixaban has the advantage of being usable across a wide range of renal function:

Creatinine Clearance (mL/min)	Recommended Dose
>95	5 or 2.5 mg twice daily*
51-95	5 or 2.5 mg twice daily*
31-50	5 or 2.5 mg twice daily*
15-30	5 or 2.5 mg twice daily*
<15 or on dialysis	5 or 2.5 mg twice daily*

*Dose depends on meeting the dose reduction criteria mentioned above 2

Important Clinical Considerations

Initiation Timing

• For new onset atrial fibrillation, apixaban can be started immediately after diagnosis if there are no contraindications
• No loading dose is required 3

Monitoring

• No routine coagulation monitoring is required
• Regular monitoring of renal function is recommended 3
• Monitor for signs of bleeding

Common Prescribing Errors

• Studies show approximately 12-17% of apixaban orders may be underdosed 4
• The most common reason for inappropriate underdosing is meeting only one dose reduction criterion (most commonly age ≥80 years) 4
• Inappropriate underdosing may lead to reduced efficacy in stroke prevention

Perioperative Management

• Discontinue apixaban at least 48 hours prior to elective surgery with moderate/high bleeding risk
• Discontinue at least 24 hours prior to procedures with low bleeding risk
• Resume after adequate hemostasis is established 1

Clinical Benefits

Apixaban has demonstrated superior outcomes compared to warfarin in patients with atrial fibrillation:

• 21% reduction in stroke or systemic embolism
• 31% reduction in major bleeding
• 11% reduction in all-cause mortality 3

Contraindications

• Mechanical heart valves
• Moderate-to-severe mitral stenosis
• Active major bleeding 3

Patient Education

• Take exactly as prescribed, twice daily
• Do not miss doses
• Do not double dose if a dose is missed
• Take missed dose as soon as remembered on the same day 1

Remember that proper dosing of apixaban is critical for balancing stroke prevention and bleeding risk in patients with atrial fibrillation. The standard dose of 5 mg twice daily should be used unless the patient meets at least two of the dose reduction criteria.