Recommended Dosing for Eliquis (Apixaban)
The recommended dose of Eliquis (apixaban) for most patients with nonvalvular atrial fibrillation is 5 mg taken orally twice daily, with dose reduction to 2.5 mg twice daily for patients with at least two of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. 1
Standard Dosing by Indication
- For nonvalvular atrial fibrillation: 5 mg orally twice daily 2, 3, 1
- For DVT/PE treatment: 10 mg orally twice daily for the first 7 days, followed by 5 mg orally twice daily 3, 1
- For reduction in risk of recurrent DVT/PE: 2.5 mg orally twice daily after at least 6 months of treatment 1
- For prophylaxis of DVT following hip or knee replacement surgery: 2.5 mg orally twice daily, with initial dose 12-24 hours after surgery 1
Dose Reduction Criteria
- Reduce to 2.5 mg twice daily if patient has at least two of the following 2, 3, 1:
- Age ≥80 years
- Body weight ≤60 kg
- Serum creatinine ≥1.5 mg/dL
Special Considerations for Renal Function
- For patients with normal to moderate renal impairment (CrCl >30 mL/min): No dose adjustment needed 4, 3
- For patients with end-stage renal disease on hemodialysis: 5 mg twice daily, reduced to 2.5 mg twice daily if age ≥80 years or body weight ≤60 kg 4
- The FDA-approved labeling does not provide specific dosage adjustments for patients with creatinine clearance 15-24 mL/min 4
Temporary Interruption for Surgery and Procedures
- For procedures with moderate to high bleeding risk: Discontinue apixaban at least 48 hours prior 1
- For procedures with low bleeding risk: Discontinue apixaban at least 24 hours prior 1
- Restart apixaban as soon as adequate hemostasis has been established 1
Missed Dose Management
- If a dose is missed, take it as soon as possible on the same day and resume twice-daily administration 1
- Do not double the dose to make up for a missed dose 1
Clinical Considerations and Cautions
- Inappropriate dose reduction is common in clinical practice, with studies showing that approximately 61% of patients receiving reduced doses do not meet criteria for dose reduction 5
- Age, weight, and serum creatinine are independent predictors for inappropriate underdosing 5
- Premature discontinuation increases the risk of thrombotic events; if discontinuation is necessary for reasons other than bleeding, consider coverage with another anticoagulant 1
- The pharmacokinetic profile of apixaban shows a half-life of approximately 12 hours with approximately 27% of clearance occurring via renal excretion 6
- Recent clinical trial evidence shows that in patients with subclinical atrial fibrillation, apixaban resulted in lower risk of stroke or systemic embolism compared to aspirin, but with higher risk of major bleeding 7
Converting From or To Apixaban
- From warfarin to apixaban: Discontinue warfarin and start apixaban when INR is below 2.0 1
- From apixaban to warfarin: Consider starting both a parenteral anticoagulant and warfarin at the time the next dose of apixaban would have been taken 1
- For switching between apixaban and anticoagulants other than warfarin: Begin the new anticoagulant at the usual time of the next scheduled dose 1