From the Guidelines
For a 93-year-old female weighing 60kg, the recommended apixaban dose is 2.5 mg twice daily, as she meets two criteria for dose reduction: age ≥80 years and weight ≤60 kg, according to the 2021 ACC expert consensus decision pathway 1. This dose reduction is crucial to minimize bleeding risk while maintaining efficacy. The medication should be taken with or without food at approximately 12-hour intervals. Renal function should be monitored periodically, as further dose adjustments may be needed if significant kidney impairment develops. Patients should be advised to report any unusual bleeding or bruising, and concomitant medications should be reviewed for potential interactions, particularly other anticoagulants, antiplatelet drugs, or NSAIDs which could increase bleeding risk. Key considerations in managing anticoagulation therapy include balancing the risk of thromboembolic events against the risk of bleeding, and the choice of anticoagulant and dosing strategy should be individualized based on patient-specific factors, as outlined in the 2021 ACC expert consensus decision pathway 1. Some studies, such as the ARISTOTLE trial, have demonstrated the efficacy and safety of apixaban in preventing stroke or systemic embolization in patients with atrial fibrillation, but the dosing recommendations from the 2021 ACC expert consensus decision pathway 1 take precedence in guiding clinical practice. The importance of monitoring renal function and adjusting the dose accordingly cannot be overstated, as significant kidney impairment may necessitate further dose reductions to prevent adverse outcomes. In clinical practice, the 2021 ACC expert consensus decision pathway 1 provides the most up-to-date guidance on apixaban dosing, and its recommendations should be followed to optimize patient outcomes. Some key points to consider when prescribing apixaban include:
- Dose reduction to 2.5 mg twice daily if the patient meets at least two of the following criteria: age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL
- Monitoring renal function periodically to adjust the dose as needed
- Reviewing concomitant medications for potential interactions that could increase bleeding risk
- Advising patients to report any unusual bleeding or bruising
- Individualizing the choice of anticoagulant and dosing strategy based on patient-specific factors.
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 a 93-year-old female weighing 60kg, two characteristics are met: age greater than or equal to 80 years and body weight less than or equal to 60 kg. The recommended dose of apixaban is 2.5 mg twice daily 2.
From the Research
Apixaban Dosing for a 93-year-old Female Weighing 60kg
- The recommended dose of apixaban is typically 5mg twice daily, but reduced-dose apixaban (2.5mg twice daily) is recommended in patients fulfilling 2 of 3 criteria: age ≥80 years, body weight ≤60 kg, and serum creatinine ≥1.5 mg/dL 3.
- Given the patient's age (93 years) and weight (60kg), she meets two of the criteria for reduced-dose apixaban.
- Studies have shown that apixaban is effective and safe in patients with atrial fibrillation, including those with renal impairment 4, 5, 6, 7.
- However, the specific dosing for a patient with these characteristics is not explicitly stated in the provided studies.
- Based on the criteria mentioned in 3, a reduced dose of 2.5mg twice daily may be considered for this patient.