From the Research
Upper Limit of Body Mass Index (BMI) for Eliquis (Apixaban)
- The upper limit of Body Mass Index (BMI) for Eliquis (apixaban) is not strictly defined, but several studies provide guidance on its use in obese patients:
- A study published in 2022 1 suggests that apixaban does not require dose adjustment in patients weighing above a certain threshold (e.g., ≥ 120 kg), and data from healthy volunteers and patients with nonvalvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) have shown that increased body weight has a modest effect on apixaban's pharmacokinetics.
- Another study from 2019 2 found that apixaban and rivaroxaban are as effective and safe as warfarin in morbidly obese patients (BMI ≥ 40 kg/m2).
- A 2022 study 3 evaluated the effectiveness and safety of apixaban in morbidly obese patients with atrial fibrillation (BMI ≥ 40 kg/m2) and found similar outcomes between morbid and non-morbid obese patients.
- A systematic review from 2020 4 recommends that rivaroxaban, apixaban, or dabigatran may be used as thromboprophylaxis in patients with BMI < 40 kg/m2, and rivaroxaban and apixaban may be administered to obese patients with VTE or AF, including BMI > 40 kg/m2, at standard fixed-dose.
- A 2024 study 5 found that apixaban and rivaroxaban are safe and effective alternatives to warfarin for the treatment of AF and/or VTE in individuals with a BMI of ≥ 50 kg/m2 and/or weight of ≥ 150 kg.
Key Findings
- Apixaban can be used in obese patients, including those with a BMI ≥ 40 kg/m2, without dose adjustment 1, 2, 3, 4.
- The safety and effectiveness of apixaban in morbidly obese patients are similar to those in non-morbidly obese patients 2, 3.
- Apixaban and rivaroxaban are safe and effective alternatives to warfarin for the treatment of AF and/or VTE in individuals with a BMI of ≥ 50 kg/m2 and/or weight of ≥ 150 kg 5.