Apixaban - adult oral tablets

Nonvalvular AF: 5 mg twice daily; use 2.5 mg twice daily when at least two apply: age >=80 years, weight <=60 kg, serum creatinine >=1.5 mg/dL. Acute DVT/PE: 10 mg twice daily for 7 days, then 5 mg twice daily. Recurrence reduction: 2.5 mg twice daily after at least 6 months of treatment.

Do not apply the AF reduction criteria to VTE treatment. For adult VTE indications, the label specifies no renal dose change, including dialysis, but CrCl <15 and dialysis patients were not enrolled in efficacy/safety studies; recommendations rely on pharmacokinetic/pharmacodynamic data. AF dialysis exposure is described, but comparable stroke and bleeding outcomes remain unknown.

The book lists usual dosing with caution at GFR 30-50 mL/min. At 15-30 it retains usual dosing for non-AF indications but lists 2.5 mg twice daily for AF. Below 15 it lists cautious use and 2.5 mg twice daily for AF. These are historical UK-reference statements, not the U.S. label's AF dose-reduction algorithm.

APD/CAPD: unlikely to be removed; refer to the <15 band. HD: described as not dialysed, with the same band. HDF/high-flux removal is unknown and uses the <15 band; CAV/VVHD removal is unknown and uses 15-30. The next page reports HD reducing exposure by 14%, so "not dialysed" must not be read as literally zero removal.

This historical published correction warns against applying atrial-fibrillation dose-reduction criteria to VTE treatment. The 2.5 mg twice-daily AF reduction requires at least two of: age >=80 years, weight <=60 kg, serum creatinine >=1.5 mg/dL, not one criterion. The reply explains that the manufacturer did not recommend the same reduction for VTE.

The authors emphasize limited trial data in advanced kidney disease: AMPLIFY excluded very low clearance, while dialysis recommendations relied on pharmacokinetic/pharmacodynamic information. This 2018 correction supports indication separation, not a new dialysis efficacy claim or a replacement for current labeling.