In atrial fibrillation, the licensed apixaban dose is 5 mg twice daily. The reduced 2.5 mg dose is indicated only when at least two of the following apply: age 80 or over, body weight 60 kg or less, serum creatinine 1.5 mg/dL (133 µmol/L) or more.
A common error is reducing the dose for one criterion alone, often age or a single creatinine reading. Each DOAC has its own reduction rules, based on different variables; they are not interchangeable.
- Check all three apixaban criteria — age 80 or over, weight 60 kg or less, creatinine 1.5 mg/dL or more — before reducing.
- One criterion alone does not justify 2.5 mg twice daily in AF.
- Recheck weight and renal function at each review; criteria change over time in both directions.
- Apply each DOAC's own dose rules; dabigatran, rivaroxaban and edoxaban use different variables.
Why it matters
Off-label underdosing is one of the commonest ways an anticoagulated patient is left unprotected.
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