What is the effective dose of Eliquis (apixaban) for Deep Vein Thrombosis (DVT) in an elderly female patient with Impaired renal function due to advanced age?

From the Guidelines

For an 80-year-old female with DVT, the effective dose of Eliquis (apixaban) should be 2.5 mg twice daily, considering her age as one of the criteria for dose reduction, as per the 2024 ESC guidelines 1. The dosing regimen for Eliquis in this patient population is crucial for minimizing the risk of bleeding complications while effectively preventing recurrent DVT.

• The initial dose for the first 7 days is typically 10 mg twice daily, but given the patient's age, the maintenance dose after this period should be adjusted to 2.5 mg twice daily if she meets at least two of the specified criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 mmol/L, as outlined in the guidelines 1.
• It is essential to assess renal function before initiating treatment, as severe renal impairment can affect the dosing and safety of Eliquis.
• The patient should be instructed to take the medication at approximately 12-hour intervals, with or without food, and to avoid concurrent use of other anticoagulants, antiplatelet drugs, and NSAIDs unless specifically directed by their physician.
• Monitoring for bleeding complications is critical, especially in elderly patients, due to their increased risk of bleeding 1.
• Eliquis works by inhibiting Factor Xa, which prevents thrombin formation and clot development, making it an effective option for both the treatment and prevention of recurrent DVT in this patient population.

From the FDA Drug Label

2.1 Recommended Dose ... Treatment of DVT and PE The recommended dose of apixaban tablets is 10 mg taken orally twice daily for the first 7 days of therapy. After 7 days, the recommended dose is 5 mg taken orally twice daily.

The effective dose of Eliquis (apixaban) for DVT in an 80-year-old female is:

• 10 mg twice daily for the first 7 days of therapy
• 5 mg twice daily after 7 days However, since the patient is 80 years old, the dose may need to be adjusted based on other characteristics, such as body weight and serum creatinine. If the patient has 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, the recommended dose is 2.5 mg twice daily. 2

From the Research

Effective Dose of Eliquis for DVT in an 80-Year-Old Female

• The effective dose of Eliquis (apixaban) for Deep Vein Thrombosis (DVT) is not explicitly stated in the provided studies for an 80-year-old female.
• However, according to the study 3, apixaban is approved for the acute treatment of DVT and pulmonary embolism, but there is a lack of data on its use in patients over 75 years old.
• Another study 4 evaluated the efficacy and safety of apixaban in patients with acute DVT, but it does not provide specific dosage recommendations for elderly patients.
• Study 5 compared apixaban with low molecular weight heparin in preventing DVT after total knee arthroplasty in older adults, but the average age of the patients was 67.8 years, which is lower than the age of the patient in question.
• Study 6 evaluated the effectiveness and safety of apixaban in patients with VTE and active cancer, but it does not provide specific dosage recommendations for elderly patients.
• Study 7 compared apixaban with warfarin in patients with severe renal failure, but it does not provide specific dosage recommendations for elderly patients.

Considerations for Elderly Patients

• The study 3 mentions that there is a dearth of data on the use of apixaban in patients over 75 years old, which may indicate a need for caution when prescribing this medication to elderly patients.
• The study 5 suggests that apixaban may be safer and more effective than low molecular weight heparin in preventing DVT in older adults, but the average age of the patients in this study was lower than the age of the patient in question.
• The studies 7, 4, and 6 do not provide specific guidance on the use of apixaban in elderly patients, but they do suggest that apixaban may be effective and safe in certain patient populations.