At SpecialtyRx, medication safety starts with careful review at every transition of care. One issue facilities and pharmacies continue to encounter involves Eliquis® (apixaban) loading-dose orders carrying over at admission without a clear stop date or transition to the maintenance dose.

For deep vein thrombosis (DVT) and pulmonary embolism (PE), Eliquis is dosed at 10 mg twice daily for the first 7 days, followed by 5 mg twice daily. The initial dose may be written as “Eliquis 5 mg, take 2 tablets twice daily.”

Common Issues to Watch For

• Admission orders for Eliquis 5 mg, 2 tablets twice daily may be carried over from the hospital without a stop date.
• Residents may have already completed some or all of the 7-day loading-dose period before arriving at the facility.
• Without careful admission review, the loading dose may continue longer than intended.
• Refills may also be processed at the higher loading dose if the intended transition is not clearly documented.

Because Eliquis is an anticoagulant, continuing a loading dose beyond its intended duration can increase the risk of medication-related harm, including bleeding.

Admission teams, prescribers, pharmacists, and consultant pharmacists all play an important role in preventing these errors. At admission, the care team should verify the indication, when treatment began, how many doses were administered before admission, and when the resident should transition to the maintenance dose.

Steps to Help Prevent Eliquis Dosing Errors

1. Confirm the indication. Determine why the resident is receiving Eliquis, such as DVT/PE treatment, atrial fibrillation, post-operative prophylaxis, or another approved indication.
2. Verify the treatment timeline. Confirm when the loading dose began and how many days were completed before admission.
3. Confirm the transition date. For DVT/PE treatment, orders should clearly identify when the loading dose ends and the maintenance dose begins. An Eliquis 10 mg twice-daily order without a clear stop or transition date should be clarified.
4. Review refills carefully. Ensure refills do not continue at the loading dose unless the prescriber has specifically confirmed that regimen.

Medication safety is a shared responsibility. Clear documentation, timely order clarification, and coordinated admission and refill reviews can help prevent dosing errors and protect the residents we serve.

At SpecialtyRx, we remain committed to working alongside our facility partners to identify potential medication risks and support safe, effective therapy.

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