Which factors require apixaban dose adjustment?

• A. All three factors
• B. Age >80 only
• C. Scr >1.5 only
• D. Weight <60 kg only

Answer: (A)

Dosing apixaban is adjusted based on factors that affect how much drug stays in the body and the patient’s risk of bleeding. The maintenance dose is lowered from 5 mg twice daily to 2.5 mg twice daily when two or more of these features are present: age 80 or older, serum creatinine 1.5 mg/dL or higher, and body weight 60 kg or less. Each factor on its own signals a higher exposure or bleed risk, so the combination clearly warrants lowering the dose. Specifically, older age can slow clearance and elevate bleeding risk; impaired renal function (as shown by higher creatinine) reduces clearance; and being under 60 kg means a smaller volume of distribution and higher drug levels for the same dose. Therefore, all three factors are reasons to adjust, with the dose reduction becoming most evident when two or more are present.