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Apixaban Dosing Post-PCI in Elderly — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyApixaban Dosing Post-PCI in ElderlyEECC

A 75-year-old woman with AF on apixaban develops acute coronary syndrome requiring PCI with DES. She weighs 48 kg and is 79 years old. What apixaban dose should she be on after PCI?

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Correct answer: A — Apixaban 5 mg bd regardless of age and weight

The correct dose is apixaban 5 mg twice daily. In non-valvular AF, apixaban is reduced to 2.5 mg twice daily only if the patient has at least 2 of the 3 dose-reduction criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 micromol/L. This patient is 79 years old, so she does not meet the age criterion; she meets only the low-weight criterion, and no raised creatinine is given. PCI with a drug-eluting stent does not itself mandate apixaban dose reduction, stopping anticoagulation, or switching to warfarin. During the post-PCI period she should receive the indicated AF anticoagulant dose, usually with clopidogrel as the antiplatelet component according to specialist ACS/PCI planning.

Reference: Apixaban 5 mg film-coated tablets Summary of Product Characteristics, electronic Medicines Compendium (UK), current: https://www.medicines.org.uk/emc/product/101368/smpc