Please check your internet connection and try again.
# Apixaban (Eliquis)
## Overview
Apixaban is a selective, reversible inhibitor of both free and clot-bound factor Xa. It reduces thrombin generation and thrombus development. It is administered orally and has a rapid onset of action.
## Primary Indications
* Reduction of risk of stroke and systemic embolism in nonvalvular atrial fibrillation.
* Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).
* Reduction in the risk of recurrent DVT and PE following initial therapy.
* Prophylaxis of DVT (which may lead to PE) following hip or knee replacement surgery.
## Adult Dosing
* **Nonvalvular AFib:** 5 mg orally twice daily.
* **Treatment of DVT/PE:** 10 mg orally twice daily for 7 days, followed by 5 mg orally twice daily.
* **Prophylaxis of recurrent DVT/PE:** 2.5 mg orally twice daily (after at least 6 months of treatment for DVT/PE).
* **Post-operative DVT Prophylaxis:** 2.5 mg orally twice daily (initiate 12–24 hours post-surgery). Duration: 12 days (knee) or 35 days (hip).
## Pediatric Dosing
**Not FDA-approved for pediatric patients.** Use in pediatrics is limited to specialized institutional protocols or clinical trials. Dosing is highly weight-based and requires expert hematology consultation.
## Dose Adjustments
* **Renal Impairment:** Generally no adjustment required for mild/moderate impairment. Use with caution in severe impairment; formal dose recommendations per product labeling (e.g., in AFib, reduce to 2.5 mg BID if at least two of the following are met: Age ≥80, Weight ≤60 kg, or Serum Creatinine ≥1.5 mg/dL). Avoid in dialysis unless otherwise specified by institutional guidelines as limited data exists (apixaban is not dialyzable).
* **Hepatic Impairment:** Avoid in severe hepatic impairment (Child-Pugh C). Use with caution in mild-to-moderate impairment (Child-Pugh A or B).
## Contraindications
* Active pathological bleeding.
* Severe hypersensitivity to apixaban.
## Adverse Effects
* **Major:** Hemorrhage (intracranial, gastrointestinal).
* **Common:** Anemia, nausea, bruising, epistaxis.
## Key Drug Interactions
* **Strong Dual Inhibitors/Inducers:** Avoid concomitant use with strong CYP3A4 and P-gp inhibitors (e.g., ketoconazole, ritonavir) and strong dual inducers (e.g., rifampin, carbamazepine, phenytoin, St. John's wort) as these significantly affect systemic exposure.
* **Antithrombotics:** Increased bleeding risk with concurrent antiplatelets (e.g., aspirin, clopidogrel), NSAIDs, or other anticoagulants.
## Monitoring
* **Baseline:** CBC, renal function (SCr/CrCl), and liver function tests.
* **Ongoing:** Periodic monitoring of renal function and hemoglobin/hematocrit. No routine monitoring of coagulation parameters (PT/INR) is required or useful; anti-Xa levels are not standard unless managing acute toxicities or urgent surgery.
* **Adherence:** High importance due to short half-life (~12 hours).
## Clinical Pearls
* **Reversal:** Andexanet alfa is the specific reversal agent for life-threatening anticoagulation reversal. Prothrombin Complex Concentrates (PCCs) are often used off-label if Andexanet is unavailable.
* **Crushability:** Tablets can be crushed and suspended in water, D5W, or apple juice/applesauce for administration via nasogastric tube.
* **Surgery:** Hold prior to elective surgical procedures based on bleeding risk; generally ≥48 hours for high-risk procedures and ≥24 hours for low-risk procedures.
***
*Disclaimer: This information is for educational purposes only. Always verify doses, contraindications, and drug interactions against current institutional protocols, the package insert, or professional clinical databases (e.g., Lexicomp, Micromedex) before prescribing or administering medication.*
