From the Research
When converting from Xarelto 20 mg to Eliquis, the recommended dose is Eliquis 5 mg twice daily for most patients. This conversion should be done carefully, with the first dose of Eliquis given at the time the next dose of Xarelto would have been due. Both medications are direct oral anticoagulants (DOACs) used to prevent stroke in atrial fibrillation and treat/prevent deep vein thrombosis and pulmonary embolism, but they have different dosing schedules and pharmacokinetics. Xarelto is taken once daily while Eliquis requires twice-daily dosing for optimal effectiveness.
Key Considerations for Conversion
- Dose adjustments may be necessary for certain patients, including those with renal impairment (reduce to Eliquis 2.5 mg twice daily if creatinine clearance is 15-29 mL/min) 1, low body weight (≤60 kg), or age ≥80 years.
- The conversion should be supervised by a healthcare provider who can assess individual patient factors and monitor for any complications.
- Both medications work by inhibiting clotting factors, though they target different points in the coagulation cascade - Xarelto inhibits Factor Xa directly while Eliquis is a direct Factor Xa inhibitor with slightly different pharmacological properties.
Evidence Supporting the Conversion
- A study published in 2023 found that apixaban (Eliquis) is safe and effective in patients with severe renal impairment, with a lower risk of bleeding and thromboembolic events compared to warfarin 1.
- Another study published in 2021 compared the safety and efficacy of direct oral anticoagulants, including apixaban, in patients with renal impairment, and found that apixaban had a favorable safety profile 2.
- A review of the literature on the use of novel oral anticoagulants in renal transplant recipients found that rivaroxaban and apixaban are safe and efficient in this population 3.
Conclusion Not Applicable
Instead, the focus is on the practical application of the evidence to guide clinical decision-making, prioritizing morbidity, mortality, and quality of life outcomes. Therefore, the recommended dose of Eliquis 5 mg twice daily should be considered in the context of individual patient factors and renal function, as evidenced by studies such as 1 and 2.