What are the recommendations for an 81-year-old patient on Eliquis (apixaban) taking a 3-hour flight?

Recommendations for an 81-Year-Old on Eliquis Taking a 3-Hour Flight

For an 81-year-old patient on Eliquis (apixaban) taking a 3-hour flight, no interruption of anticoagulation is necessary, and the patient should continue their regular Eliquis dosing schedule without modification.

Dosing Considerations for Elderly Patients on Apixaban

For an 81-year-old patient on Eliquis, dosing considerations are important:

• The standard dose of apixaban for atrial fibrillation is 5 mg twice daily 1
• However, dose reduction to 2.5 mg twice daily is recommended if the patient has at least two of the following characteristics 2:
  • Age ≥80 years (which applies to this patient)
  • Body weight ≤60 kg
  • Serum creatinine ≥1.5 mg/dL

Since this patient is 81 years old, they likely qualify for the reduced 2.5 mg twice-daily dose if they have at least one other risk factor (low weight or elevated creatinine) 1.

Air Travel Recommendations

For a 3-hour flight:

1. Continue regular Eliquis dosing

   • Do not interrupt anticoagulation for short flights
   • Take the medication according to the usual schedule

2. Hydration and mobility

   • Drink adequate fluids before and during the flight
   • Avoid excessive alcohol and caffeine which can contribute to dehydration
   • Perform leg exercises while seated (ankle circles, foot pumps)
   • Walk in the aisle when safe to do so (approximately every hour)

3. Compression stockings

   • Consider wearing compression stockings for additional DVT prevention, especially if the patient has other risk factors for thrombosis

Important Considerations

• No need to bridge or adjust dosing: Unlike warfarin, Eliquis has a shorter half-life and more predictable pharmacological profile, making it unnecessary to adjust dosing for short flights 1

• Medication timing: If a dose is scheduled during the flight, the patient should take it as close to the regular time as possible. If a dose is missed, it should be taken as soon as remembered on the same day, but the dose should not be doubled 2

• Carry medication in hand luggage: The patient should keep Eliquis in their carry-on luggage, not in checked baggage, and bring enough medication for the entire trip plus extra in case of delays

• Medical identification: The patient should carry medical identification indicating they are on anticoagulation therapy

Potential Complications to Watch For

• Bleeding risk: While the risk of bleeding during a short flight is minimal, patients should be aware of signs of bleeding (unusual bruising, nosebleeds, blood in urine/stool)

• Drug interactions: Verify the patient isn't taking medications that might interact with apixaban, such as strong CYP3A4 inhibitors or P-glycoprotein inhibitors, which could increase bleeding risk 1, 2

This 3-hour flight poses minimal additional risk for an elderly patient properly anticoagulated with Eliquis, and maintaining the regular dosing schedule is the most important recommendation.