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Apixaban Renal Dosing

Apixaban Renal Dosing


apixaban renal dosing should be swallowed with water, with or without food.

For patients who are unable to swallow whole tablets, Eliquis tablets may be crushed and suspended in water, or 5% dextrose in water (D5W), or apple juice or mixed with apple puree and immediately administered orally (see section 5.2). Alternatively, Eliquis tablets may be crushed and suspended in 60 mL of water or D5W and immediately delivered through a nasogastric tube


Thromboprophylaxis: 2.5 mg twice daily (BID) starting 12-24 h after surgery and continuingfor 14 or 30 days after knee or hip replacement, respectively b) Stroke prevention in atrial fibrillation: 5 mg BID. No dose adjustment is necessary in patientswith mild renal impairment (CrCl > 50 mL/min). In patients with moderate renal impairment(CrCl 25-50 mL/min) 5 mg BID can be used but 2.5 mg BID should be given in patients with 2of 3 of the following characteristics: (1) serum creatinine ≥ 133 µmol/L (1.5 mg/dL); (2) age ≥80 years; (3) body weight ≤ 60 kg. In patients with CrCl 15-24 mL/min, no dosingrecommendation can be made as clinical data are very limited.

Side Effects

  • Blood in the eyes
  • blood in the urine
  • bloody or black, tarry stools
  • bruising or purple areas on the skin
  • confusion
  • constipation
  • coughing up blood
  • decreased alertness
  • difficulty swallowing
  • dizziness
  • fainting
  • fast heartbeat
  • headache
  • hives, itching, skin rash
  • joint pain or swelling
  • nausea and vomiting
  • nosebleeds
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the eye


There are no studies evaluating the use of apixaban renal dosing in children, although studies are underway.Apixaban in children is not recommended until dosing, safety and efficacy are confirmed. SeePediatrics guide. Pediatricians with expertise in thromboembolism should manage, wherepossible, pediatric patients with thromboembolism. When this is not possible, a combination of aneonatologist/pediatrician and an adult hematologist, supported by consultation with an experienced pediatric hematologist, is recommended.

Missed dose

If a dose is missed, the patient should take apixaban renal dosing immediately and then continue with twice daily intake as before.


The large-scale randomized clinical trials that led to approval of dabigatran, rivaroxaban, and apixaban renal dosing for stroke prevention in AF patients in the United States all excluded patients with ESKD and therefore provided no data on safety/efficacy in this subgroup of patients. The off-label use of dabigatran and rivaroxaban has been associated with poor outcomes in ESKD patients. Apixaban is less dependent on renal excretion, and based on pharmacokinetic data, current labeling recommends standard-dose apixaban in dialysis patients. Until now, however, there have been no data on clinical outcomes. This important study for the first time provides solid evidence supporting the use of standard-dose apixaban in dialysis-dependent AF patients.


Standard-dose apixaban renal dosing is both safer and more effective than warfarin for stroke prevention in dialysis-dependent patients with AF.

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