What is the home dose of Eliquis (apixaban) 2.5 mg orally (po) twice daily (bid) after knee surgery?

Home Dosing of Eliquis (Apixaban) 2.5 mg After Knee Surgery

The home dose of Eliquis (apixaban) for VTE prophylaxis after knee replacement surgery is 2.5 mg orally twice daily for 12 days total, with the first dose initiated 12-24 hours after surgery. 1

Standard Dosing Protocol

• Dose: 2.5 mg taken orally twice daily 1
• Duration: 12 days for knee replacement surgery (compared to 35 days for hip replacement) 1, 2
• Timing of first dose: 12-24 hours after surgery 1
• When to resume: Only after adequate hemostasis has been established 2, 3

Key Considerations for Safe Home Discharge

Renal Function Monitoring

• Surgical procedures can affect renal function postoperatively, which impacts apixaban elimination 2
• Creatinine clearance should be assessed, as apixaban has a half-life of 7-8 hours in patients with normal renal function 4
• Patients with moderate renal impairment (CrCl 30-50 mL/min) may require extended monitoring 3

Patient Education on Missed Doses

• If a dose is missed, take it as soon as possible on the same day 1
• Resume twice-daily administration as scheduled 1
• Never double the dose to make up for a missed dose 1

Bleeding Risk Assessment

• Individual bleeding risk should be considered when determining exact timing of the first dose 2
• Monitor for signs of major bleeding, though the risk is low with this prophylactic regimen 5
• Clinically relevant nonmajor bleeding occurs in approximately 4.8% of patients on apixaban 6

Common Pitfalls to Avoid

Inadequate Duration

• Do not stop prophylaxis early - the full 12-day course is necessary for knee replacement 2
• Premature discontinuation increases VTE risk without reducing bleeding complications 2

Drug Interactions

• Avoid concomitant strong P-glycoprotein inhibitors and CYP3A4 inhibitors without dose adjustment 2
• These interactions can significantly increase apixaban levels and bleeding risk 3

Overlapping Anticoagulation

• If the patient was on anticoagulation preoperatively, ensure proper transition without overlap 2
• Do not administer apixaban simultaneously with other anticoagulants unless specifically bridging under protocol 1

Neuraxial Anesthesia Considerations

• If an epidural catheter was used, special timing considerations apply for apixaban administration 2
• Ensure adequate time has elapsed since catheter removal before initiating apixaban 3

Alternative Immediate Postoperative Options

• If immediate VTE prophylaxis is needed before apixaban can be safely started, heparin or fondaparinux can be administered at least 6 hours after the procedure 2, 3
• Transition to apixaban once hemostasis is confirmed 3

Efficacy Data

• In a large multicenter study of 5,017 bariatric patients, the 2.5 mg twice daily regimen for 30 days resulted in only 0.1% thromboembolic complications when the protocol was followed 5
• No deaths or thromboembolic events occurred when the full protocol was completed 5