Dosing considerations in patients with 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.
ELIQUIS is not recommended in patients with CrCl <15 ml/min, or in patients undergoing dialysis.1
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
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
- ELIQUIS® (apixaban) Summary of Product Characteristics.
- NICE clinical guideline 182. Chronic kidney disease in adults: assessment and management. January 2015. Available at: www.nice.org.uk/guidance/cg182.
- NICE clinical guideline 180. Atrial fibrillation: management. August 2014. Available at: www.nice.org.uk/guidance/cg180.
- Steffel J et al. Eur Heart J 2018; 39: 1330–1393.