From the Guidelines
For atrial fibrillation, the standard apixaban dose is 5 mg taken orally twice daily, but it 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, or serum creatinine ≥1.5 mg/dL (133 μmol/L). This recommendation is based on the most recent guidelines, including the 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation 1. The dose reduction is also recommended for patients with severe renal impairment, although the specific creatinine clearance threshold may vary. Apixaban works by inhibiting factor Xa, preventing the formation of blood clots that could lead to stroke in atrial fibrillation patients.
Key Considerations
- The standard dose of apixaban is 5 mg twice daily, but dose reduction to 2.5 mg twice daily is recommended for patients with certain characteristics, such as age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL (133 μmol/L) 1.
- Apixaban should be taken consistently at approximately 12-hour intervals, with or without food.
- Patients should inform all healthcare providers about taking apixaban before any procedures, as it may need to be temporarily discontinued to prevent bleeding complications.
- Regular monitoring of renal function is recommended while on this medication, though routine coagulation monitoring is not required.
Evidence Summary
The 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation provides the most recent recommendations for apixaban dosing 1. The guideline recommends a standard dose of 5 mg twice daily, with dose reduction to 2.5 mg twice daily for patients with certain characteristics. The ARISTOTLE trial, which compared apixaban to warfarin in patients with atrial fibrillation, demonstrated the efficacy and safety of apixaban in preventing stroke and systemic embolism 1.
Clinical Implications
The recommended dose of apixaban for atrial fibrillation should be individualized based on patient characteristics, such as age, body weight, and renal function. Healthcare providers should carefully evaluate patients for dose reduction criteria and monitor renal function regularly while patients are on apixaban. By following these guidelines and recommendations, healthcare providers can optimize the use of apixaban in patients with atrial fibrillation and reduce the risk of stroke and systemic embolism.
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 dose of apixaban for atrial fibrillation is 5 mg taken orally twice daily for most patients, and 2.5 mg twice daily for patients with at least two of the specified characteristics 2.
From the Research
Apixaban Dosing for Atrial Fibrillation
- The recommended dose of apixaban for atrial fibrillation is 5 mg twice daily, with a reduced dose of 2.5 mg twice daily for patients with at least two of the following criteria: age 80 years or older, weight 60 kg or less, and creatinine level 1.5 mg/dL or higher 3.
- Patients with only one dose-reduction criterion (advanced age, low body weight, or renal dysfunction) can safely receive the 5 mg twice daily dose of apixaban, with consistent benefits compared to warfarin 3.
- A study of patients with non-valvular atrial fibrillation and severe renal impairment found that apixaban 5 mg twice daily was safe and effective, with no significant difference in major bleeding events compared to patients with preserved renal function 4.
- Another study found that about 40% of direct oral anticoagulant prescriptions, including apixaban, featured inappropriate dose levels in patients aged 80 years and over with non-valvular atrial fibrillation 5.
- Apixaban concentrations in older adults with atrial fibrillation were found to be higher than expected based on clinical trial data, raising questions about the optimal dosing of apixaban in this population 6.
- A retrospective analysis of Japanese patients with non-valvular atrial fibrillation found that apixaban was associated with a significantly lower risk of any bleeding compared to warfarin, with a trend towards increased risk reduction with apixaban in patients with body weight ≥60 kg 7.