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Apixaban Dose Reduction Criteria — EECC MCQ

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EasyArrhythmia & ElectrophysiologyApixaban Dose Reduction CriteriaEECC

A 80-year-old woman with AF on apixaban 5 mg bd weighs 58 kg and has a creatinine of 110 micromol/L (estimated CrCl 32 mL/min). She is being assessed for apixaban dose adjustment. Does she qualify for the reduced dose of 2.5 mg bd?

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Correct answer: D — Reduce apixaban because age and weight criteria are both met

Apixaban dose reduction from 5 mg bd to 2.5 mg bd is recommended when ≥2 of 3 criteria are met: (1) age ≥80 years, (2) body weight ≤60 kg, (3) serum creatinine ≥133 micromol/L (133 µmol/L). This patient meets 2 criteria (age 80, weight 58 kg) even though her creatinine is only 110 — dose reduction is therefore indicated. The ARISTOTLE trial subgroup analyses confirmed the safety and efficacy of reduced-dose apixaban in these patients. Common errors include: reducing dose based on a single criterion (particularly renal function alone) or not reducing when 2 criteria are met. Apixaban is the only DOAC where renal function is not the sole dose-determining factor.

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation; ARISTOTLE Trial: https://bnf.nice.org.uk/