Twice daily does not always mean every 12 hours real world apixaban dosing

Apixaban should be taken at 12-hour intervals to ensure stable anticoagulation1. Many patients interpret "twice daily" as taking 2 tablets per day, leading to incorrect dosing intervals and potential loss of protection. This audit assessed adherence across inpatient, community, and integrated cardiovascular care settings.

To determine whether patients took apixaban at 12-hour intervals, identify patterns of incorrect dosing, and assess whether age influenced correct dosing.

A cross-sectional audit was conducted among adults prescribed apixaban across inpatient services, community pharmacy, and integrated cardiovascular care settings within a regional health service. Patients self-reported usual dosing times, which were compared with the recommended 12-hour dosing interval. Correct dosing was defined as administration within ±1 hour of a 12-hour interval. Demographic data were collected, and logistic regression analysis was performed to examine the association between age and correct dosing behaviour.

• Total sample: 95 patients (55 males, 58%), aged 42–98 years

• Correct 12-hour dosing: 23 patients (24%)

• Incorrect interval: 72 patients (76%)

• Once-daily dosing: 1 patient (1%) (only taking one tablet a day)

• Both tablets taken together in the morning: 5 patients (5.3%)

• Second tablet taken too early: 42 patients (44%):

Intervals ranged 1–11 hours (average 3 hours early)

• Second tablet taken late: 24 patients (25%)

Intervals ranged 13–16 hours (average 2 hours late)

• Participants aged ≤ 65 years had 28 % lower odds of adhering to 12-hourly dosing than those aged > 65 years (OR = 0.72). However, the difference was not statistically significant (p ≈ 0.98)

Among participants aged ≤ 65 years (n = 12), 25 % adhered to 12-hourly dosing compared with 31 % of those aged > 65 years (n = 83). Although younger adults had lower odds of adherence (OR = 0.72, p = 0.98), this difference was not significant, suggesting that age was not a major determinant of correct dosing interval.

Only one-quarter of patients were administered apixaban at the recommended 12-hour interval. Misinterpretation of "twice daily" dosing was common, while age was not associated with correct dosing. Clearer patient education is needed to support safe and effective anticoagulation.  

1 in 4 follow Recommended Dosing