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Dosing considerations based on renal function1

Level of renal function NVAF patients DVT or PE patients
Normal
(CrCl >80 ml/min)
5 mg taken orally twice daily
OR
2.5 mg taken orally twice daily in patients
with at least two of the following
characteristics: age ≥80 years, body weight
≤60 kg, or serum creatinine ≥1.5 mg/dL
(133 µmol/l).1
No Dose Adjustment is necessary
Mild
(CrCl 51–80 ml/min)
Moderate
(CrCl 30–50 ml/min)
Severe
(CrCl 15–29 ml/min)
Patients should receive the lower
dose of ELIQUIS 2.5 mg
twice daily
ELIQUIS is to be used with caution
(CrCl <15 ml/min) ELIQUIS is not recommended ELIQUIS is not recommended
Undergoing dialysis

NICE CG182 suggests considering ELIQUIS in preference to warfarin in people with a confirmed eGFR of 30–50 ml/min/1.73 m2 and NVAF who have ≥1 of the following risk factors: prior stroke or transient ischemic attack; age ≥75 years; hypertension; diabetes mellitus; symptomatic heart failure.2*

Dosing considerations in patients with hepatic impairment across all indications1

Hepatic impairment
Mild or moderate hepatic impairment (Child-Pugh A or B) Use with caution
No dose adjustment required
Elevated liver enzymes (ALT / AST >2 x ULN) or total bilirubin ≥1.5 x ULN Use with caution
Severe hepatic impairment Not recommended
Hepatic disease associated with coagulopathy and clinically relevant bleeding risk Contraindicated

Prior to initiating ELIQUIS, liver function testing should be performed.1

EHRA recommends that patients with NVAF undergoing treatment with NOACs have blood samples taken yearly to assess haemoglobin, renal function and liver function4

If patients are ≥75 years old or frail, samples should be taken every 6 months.4 For patients with renal function CrCl ≤60 ml/min, samples should be taken x-monthly, where x = CrCl/10.

Purple information icon ELIQUIS (apixaban) SmPC

Please click here to access the ELIQUIS SmPC.

Purple information icon ELIQUIS (apixaban) Patient Information Leaflet

Please click here to access the ELIQUIS Patient Information Leaflet.

* ELIQUIS, dabigatran etexilate, rivaroxaban and VKA are all recommended by NICE Clinical Guideline 180 (NICE CG180, 2014) as anticoagulation therapy options for the prevention of stroke in patients with NVAF in line with their respective marketing authorisations.3 Edoxaban was not considered for inclusion in either of the NICE guidelines (NICE CG180, 2014 and NICE CG182, 2015) as it did not have EU marketing authorisation at the time of publication. However, all NOACs have now received NICE Technology Appraisal guidance (NICE TA249 [dabigatran]), NICE TA256 [rivaroxaban], NICE TA275 [apixaban], and NICE TA355 [edoxaban]), and all NOACs are recommended as an option for preventing stroke and systemic embolism in patients with NVAF and one or more risk factors, in line with their respective marketing authorisations.2,3 † Frailty is defined as three or more criteria of unintentional weight loss, self-reported exhaustion, weakness assessed by handgrip test, slow walking speed or low physical activity.5

ALT = Alanine Aminotransferase AST = Aspartate Aminotransferase CrCl = Creatinine Clearance DVT = Deep Vein Thrombosis eGFR = Estimated Glomerular Filtration Rate NICE = National Institute for Health and Care Excellence NVAF = Non-Valvular Atrial Fibrillation PE = Pulmonary Embolism ULN = Upper Limit of Normal

References

  1. ELIQUIS® (apixaban) Summary of Product Characteristics.
  2. NICE clinical guideline 182. Chronic kidney disease in adults: assessment and management. January 2015. Available at: www.nice.org.uk/guidance/cg182.
  3. NICE clinical guideline 180. Atrial fibrillation: management. August 2014. Available at: www.nice.org.uk/guidance/cg180.
  4. Steffel J et al. Eur Heart J 2018; 39: 1330–1393.
  5. Heidbuchel H et al. Europace 2015; 17: 1467–1507.