In atrial fibrillation, the label dose of apixaban is 5 mg twice daily. The reduced 2.5 mg dose is indicated when at least two of three criteria are met: age 80 or over, body weight 60 kg or less, serum creatinine 1.5 mg/dL (133 µmol/L) or more. One criterion alone is not enough. Reducing the dose for age or frailty alone is one of the commonest forms of DOAC underdosing.
- Age ≥80, weight ≤60 kg, creatinine ≥1.5 mg/dL: two needed for 2.5 mg twice daily.
- Recheck weight and creatinine at review; patients can move in or out of the reduced-dose group.
- Each DOAC has its own reduction criteria; do not carry one drug's rules over to another.
- Record the reason for any reduced dose in the notes.
Why it matters
Off-label dose reduction trades a small bleeding fear for a larger stroke risk.
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