Risk factors for stroke in NVAF include prior stroke or transient ischaemic attack, age ≥75 years, hypertension, diabetes mellitus, and symptomatic heart failure (NYHA Class ≥II).
The recommended dose of apixaban is 5 mg taken orally twice daily with water, with or without food. Therapy should be continued long-term (Figure 1).
For patients who are unable to swallow whole tablets, apixaban tablets may be crushed and suspended in water, or 5% glucose in water (G5W), or apple juice or mixed with apple puree and immediately administered orally. Alternatively, apixaban tablets may be crushed and suspended in 60 mL of water or G5W and immediately delivered through a nasogastric tube. Crushed apixaban tablets are stable in water, G5W, apple juice, and apple puree for up to 4 hours.
In patients with at least two of the following characteristics: age ≥80 years, body weight ≤60kg, or serum creatinine ≥1.5 mg/dL (133 µmol/L), the recommended dose of apixaban is 2.5 mg taken orally twice daily (Figure 2).
Patients with exclusive criteria of severe renal impairment (creatinine clearance [CrCl] 15–29 ml/min) should also receive apixaban 2.5 mg twice daily (Figure 2).
Age ≥80 years
Body weight ≤60 kg
≥1.5 mg/dL (133 µmol/L)
At least 2 characteristics
2.5 mg twice daily
If a dose is missed, the patient should take apixaban immediately and then continue with twice daily intake as before.
Click below for information on use in specific patient populations.
(CrCl <15 ml/min)
|Severe renal impairment (CrCl 15–29 ml/min)||Dose reduction to
|Mild (CrCl 51–80 ml/min) or moderate
||5 mg twice daily. No dose adjustment required unless the patient fulfils criteria for dose reduction to 2.5 mg twice daily based on age, body weight and/or serum creatinine (refer to dosing section)|
|Hepatic disease associated with coagulopathy and clinically relevant bleeding risk||Contraindicated|
|Severe hepatic impairment||Not recommended|
|Mild or moderate hepatic impairment
(Child Pugh A or B)
|Use with caution
No dose adjustment required
Prior to initiating apixaban, liver function testing should be performed. Patients with elevated liver enzymes alanine aminotransferase (ALT)/aspartate aminotransferase (AST) >2 x ULN or total bilirubin ≥1.5 x ULN were excluded in clinical studies. Therefore, apixaban should be used cautiously in this population.
Apixaban can be continued in patients undergoing catheter ablation for atrial fibrillation.
Apixaban can be initiated or continued in NVAF patients who may require cardioversion.
For patients not previously treated with anticoagulants, exclusion of left atrial thrombus using an image-guided approach (e.g. transesophogeal echocardiography [TEE] or computed tomographic scan [CT]) prior to cardioversion should be considered, in accordance with established medical guidelines.
For patients in whom a prior intracardiac thrombus has been detected, established medical guidelines should be followed prior to cardioversion.
|Patient status||Patient qualifies for dose reduction?||Dosing regimen|
|Initiating treatment with apixaban||No||5mg twice daily for at least 2.5 days (5 single doses) before cardioversion|
|Yes||2.5mg twice daily for at least 2.5 days (5 single doses) before cardioversion|
|Insufficient time prior to cardioversion to administer 5 doses of apixaban||No||10 mg loading dose at least 2 hours before cardioversion, followed by 5 mg twice daily|
|Yes||5 mg loading dose at least 2 hours before cardioversion, followed by
For all patients undergoing cardioversion, confirmation should be sought prior to cardioversion that the patient has taken apixaban as prescribed.
Decisions on initiation and duration of treatment should take established guideline recommendations for anticoagulant treatment in patients undergoing cardioversion into account.
This Prescriber Guide is not a substitute for the apixaban Summary of Product Characteristics (SmPC). Please consult the SmPC for full prescribing information.