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# Apixaban (Eliquis)
## Overview
Direct oral anticoagulant (DOAC), selective factor Xa inhibitor. Rapid onset, predictable pharmacokinetics, fixed dosing without routine coagulation monitoring.
## Primary Indications
- Non-valvular atrial fibrillation (AFib)
- Venous thromboembolism (VTE): treatment and secondary prevention
- VTE prophylaxis after hip/knee replacement surgery
## Adult Dosing
**AFib – Stroke Prevention:**
- Standard: 5 mg twice daily
- Reduce to 2.5 mg twice daily if ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL (meet ≥2 criteria)
**VTE Treatment:**
- 10 mg twice daily for 7 days, then 5 mg twice daily
**VTE Prophylaxis (post-hip/knee replacement):**
- 2.5 mg twice daily; start 12–24 hours after surgery
- Hip: 35 days; Knee: 12 days
**Maximum dose:** 10 mg twice daily (acute VTE only)
## Pediatric Dosing
Dosing is weight- and indication-specific; exact pediatric dosing depends on local protocol and body weight. Approved for VTE treatment and prophylaxis in children (≥1 year). Doses range from 2.5 mg to 10 mg twice daily based on weight bands (consult current product monograph for weight-based tables).
## Dose Adjustments
- **Renal:** Avoid use if CrCl <15 mL/min (unapproved). Use with caution if CrCl 15–29 mL/min; reduce dose per AFib criteria if applicable.
- **Hepatic:** Avoid in severe hepatic impairment (Child-Pugh C).
- **Dual therapy (e.g., antiplatelets):** Use lowest effective dose; increased bleeding risk.
## Contraindications
- Active pathological bleeding
- Severe hypersensitivity to apixaban
- Mechanical heart valves (ineffective)
- Antiphospholipid syndrome (triple-positive), especially valvular
## Adverse Effects
- Bleeding (major, minor, GI, intracranial)
- Anemia, epistaxis, hematuria, bruising
- Rare: anaphylaxis, hepatic injury
## Key Drug Interactions
- Avoid concurrent strong dual inhibitors of CYP3A4 and P-glycoprotein (e.g., ketoconazole, ritonavir)
- Reduce dose if given with strong dual inhibitors per local protocol
- Avoid strong inducers (e.g., rifampin, phenytoin, carbamazepine)
- Antiplatelets, NSAIDs, SSRIs increase bleeding risk
## Monitoring
- No routine INR or aPTT monitoring; anti-factor Xa assay available but not required
- Assess renal function, CBC, and liver enzymes at baseline and periodically
- Monitor for bleeding signs
## Clinical Pearls
- Most predictable dosing among DOACs; lower GI bleeding risk vs. warfarin
- Reversal agent: andexanet alfa (recombinant factor Xa decoy)
- Do not use in patients with mechanical heart valves or triple-positive antiphospholipid syndrome (risk of thrombotic events)
- Strict adherence to twice-daily schedule; missed dose: take if >6 hours until next dose; if <6 hours, skip
*Educational disclaimer: This information is for educational purposes only and does not replace clinical judgment. Always verify current prescribing information from the manufacturer’s product monograph or local guidelines before prescribing or dispensing.*
