Do you make any dose adjustments for patients with ESKD who are on apixaban and do not otherwise meet criteria for reduced dosing?

I do most of the time but it depends on the indication and patient's weight and age. For soft indications, I usually give 2.5 mg bid, but if there is a significant risk (stroke, clots, etc), I will give a full dose of 5 mg bid.

I’ve seen some major bleeding due to apixaban such as retroperitoneal bleed. No ability to monitor to coagulation profile has left me with being more cautious.

Apixiban is a game-changer for patients with a fib and various clots. I am very cautious about dosing since there are new monitoring mechanisms.