From the Guidelines
For patients over 80 years old taking Eliquis (apixaban), the recommended dose is typically reduced to the lower dose of 2.5 mg twice daily rather than the full dose of 5 mg twice daily, as indicated in the 2024 ESC guidelines for the management of atrial fibrillation 1. The dose reduction is based on specific criteria, including age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 mmol/L, with the requirement that at least two of these criteria must be met for the dose reduction to be considered. Key points to consider when determining the appropriate dose of Eliquis in patients over 80 years old include:
- Age-related changes in kidney function, which can affect the clearance of apixaban and increase the risk of bleeding complications
- Decreased body mass, which can also impact the clearance of apixaban and increase the risk of bleeding
- Greater likelihood of drug interactions due to the use of multiple medications, which can further increase the risk of bleeding complications
- Increased risk of falls and bleeding due to fragile blood vessels The reduced dose of 2.5 mg twice daily aims to balance the benefits of preventing strokes and blood clots with the risks of bleeding complications in elderly patients. It is essential to note that the specific dosing of Eliquis should always be determined by a healthcare provider who can evaluate individual risk factors, kidney function, and other medications that might interact with Eliquis, as recommended in the 2024 ESC guidelines 1.
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
For patients over 80 years old, the low dose of Eliquis (apixaban) is 2.5 mg twice daily if they have at least one other characteristic (body weight less than or equal to 60 kg or serum creatinine greater than or equal to 1.5 mg/dL), otherwise the full dose is 5 mg twice daily 2.
From the Research
Eliquis Dosing in Patients Over 80
- The optimal dosing of Eliquis (apixaban) in patients over 80 years old with atrial fibrillation is a topic of ongoing research 3, 4.
- A retrospective study published in 2022 found that patients over 80 years old with atrial fibrillation who were prescribed a reduced dose of direct-acting oral anticoagulants (DOACs), including apixaban, had similar rates of stroke and systemic embolism, but higher rates of non-central nervous system bleeding and mortality compared to those prescribed a full dose 3.
- Another study published in 2023 found that very low dose non-vitamin K antagonist oral anticoagulants (NOACs), including apixaban, were associated with a higher risk of major adverse limb events, venous thrombosis, and all-cause mortality compared to regular-dose NOACs in elderly atrial fibrillation patients at increased bleeding risk 4.
- A meta-analysis published in 2015 found that apixaban was associated with a lower risk of bleeding in patients with mild renal impairment, but a similar risk of bleeding in patients with moderate to severe renal impairment compared to conventional anticoagulants 5.
- A sub-analysis of a national registry published in 2021 found that apixaban may be a reasonable alternative to warfarin in patients with severe renal impairment, with lower rates of mortality and composite outcomes compared to warfarin 6.
- Key factors to consider when determining the optimal dose of Eliquis in patients over 80 years old include: