Apixaban - Renal Dose Adjustments and Renal Function Effects

The presence of chronic kidney disease is an independent risk factor for increased bleeding events, including hemorrhagic stroke. Please carefully consider the risks and benefits of any oral anticoagulant prior to initiating therapy.

 

Chang M et al.  Effect of renal impairment on the pharmacokinetics, pharmacodynamics and safety of apixaban.  J Clin Pharmacol 2016; 56:637-645

CrCl     FDA Recommended Dose for Stroke Prevention in Atrial Fibrillation                                    Treatment of VTE AUC                  t 1/2             
> 80 ml/min 5mg bid
 

2.5mg bid if any two of the following:

Scr > 1.5

Age > 80 years

Body weight < 60 kg

10mg bid x 7 days,

then 5mg bid

(reference) 15.1 hrs
50-79 ml/min 16% increase 14.6 hrs
30-49 ml/min 29% increase 17.6 hrs
15-29 ml/min

Use with caution

Clinical trials excluded patients with serum creatinine > 2.5 or CrCl < 25 ml/min

Use with caution, consider alternative therapy

Clinical trials excluded patients with serum creatinine > 2.5 or CrCl < 25 ml/mi

44% increase 17.3 hrs
 
< 15 ml/min Not recommended not reported
Hemodialysis 3 times per week Use with caution

Avoid use, no data for use in this population

not reported  

NOTE:  Use for long-term DVT/PE prevention and DVT/PE prevention in hip/knee replacment (2.5 mg twice daily) the manufacturer does not recommend dose adjustment. However, patients with CrCl < 15 ml/min or receiving dialysis were excluded from clinical trials.