In an 81-year-old patient with paroxysmal atrial fibrillation on apixaban 5 mg twice daily, weight 59 kg, and creatinine 120 mmol/L, what is the most appropriate apixaban dose to continue?

In an 81-year-old patient with paroxysmal atrial fibrillation on apixaban 5 mg twice daily, weight 59 kg, and creatinine 120 mmol/L, what is the most appropriate apixaban dose to continue?

• A. Apixaban 2.5 mg BD
• B. Apixaban 5 mg BD
• C. Apixaban 5 mg daily
• D. Apixaban 2.5 mg daily

Answer: (A)

Apixaban dosing in atrial fibrillation uses a standard 5 mg twice daily, with a reduction to 2.5 mg twice daily if at least two of these factors are present: age 80 or older, body weight 60 kg or less, or serum creatinine 1.5 mg/dL or higher. In this patient, age is 81 and weight is 59 kg, so two criteria are met. That mandates the reduced dose of 2.5 mg twice daily to balance stroke prevention with bleeding risk. The other options either keep the full standard dose, switch to a daily regimen, or reduce to 2.5 mg once daily, none of which align with the guideline for two risk factors.

Apixaban dosing in atrial fibrillation uses a standard 5 mg twice daily, with a reduction to 2.5 mg twice daily if at least two of these factors are present: age 80 or older, body weight 60 kg or less, or serum creatinine 1.5 mg/dL or higher. In this patient, age is 81 and weight is 59 kg, so two criteria are met. That mandates the reduced dose of 2.5 mg twice daily to balance stroke prevention with bleeding risk. The other options either keep the full standard dose, switch to a daily regimen, or reduce to 2.5 mg once daily, none of which align with the guideline for two risk factors.