An 83-year-old client with nonvalvular atrial fibrillation weighs 58 kg and has a serum creatinine of 1.3 mg/dL. Which apixaban dose should the nurse expect?
12.5 mg orally 2 times per 1 day because the client meets 2 dose-reduction criteria.✓ Correct answer
25 mg orally 2 times per 1 day because serum creatinine is below 1.5 mg/dL.
310 mg orally 2 times per 1 day for 7 days because every atrial-fibrillation client uses the acute VTE regimen.
4No anticoagulant can be used after age 80 years.
Explanation
For nonvalvular atrial fibrillation, age 80 years or older and weight 60 kg or less are 2 qualifying criteria, so the labeled dose is 2.5 mg 2 times per 1 day.
Quick answer Expect apixaban 2.5 mg 2 times per 1 day.
Why this is correct The nonvalvular atrial-fibrillation label reduces the dose when at least 2 of 3 characteristics are present: age at least 80, weight at most 60 kg, or serum creatinine at least 1.5 mg/dL. This client meets age and weight.
Easy analogy or mental picture 2 checked boxes open the reduced-dose pathway; the remaining box does not have to be checked.
Memory hook Apixaban AF: any 2 of age 80, weight 60, creatinine 1.5.
NCLEX decision rule Confirm the indication, then count the exact criteria; do not borrow a regimen from a different indication.
Why the other choices are wrong The VTE loading regimen does not apply to routine AF stroke prevention, and age alone is not a blanket contraindication.
References
1DailyMed: Apixaban TabletsTwo-of-three reduction rule for nonvalvular atrial fibrillation
Indication-specific anticoagulant dosingConfirm indication, age, weight, serum creatinine, bleeding risk, interacting drugs, and the exact labeled regimen.