Apixaban%2525252525252525252520%2525252525252525252528eliquis%2525252525252525252529

# Apixaban (Eliquis) ## Overview Apixaban is a highly selective, reversible, oral direct Factor Xa inhibitor. It prevents thrombus formation by inhibiting both free and clot-bound Factor Xa, and indirectly inhibits platelet aggregation induced by thrombin. ## Primary Indications * Reduction of risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). * 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) in patients who have undergone hip or knee replacement surgery. ## Adult Dosing * **NVAF:** 5 mg PO twice daily. Reduce to 2.5 mg twice daily if criteria for dose reduction are met (see Dose Adjustments). * **DVT/PE Treatment:** 10 mg PO twice daily for 7 days, followed by 5 mg PO twice daily. * **DVT/PE Recurrence Prevention:** 2.5 mg PO twice daily after at least 6 months of treatment for DVT/PE. * **Post-op Orthopedic Prophylaxis (Hip Replacement):** 2.5 mg PO twice daily for 35 days. Start 12–24 hours post-operatively. * **Post-op Orthopedic Prophylaxis (Knee Replacement):** 2.5 mg PO twice daily for 12 days. Start 12–24 hours post-operatively. ## Pediatric Dosing **Use is not routinely established.** Dosing is determined by institutional pediatric hematology protocols within clinical trials or specialized settings. Caution: Safety and efficacy have not been established; avoid unlabeled use in pediatric populations outside of specialized clinical guidance. ## Dose Adjustments * **NVAF Dose Reduction:** Reduce to 2.5 mg twice daily if the patient meets **at least two** of the following: Age ≥ 80 years, Body weight ≤ 60 kg, or Serum creatinine ≥ 1.5 mg/dL. * **Hepatic Impairment:** Avoid in severe hepatic impairment (Child-Pugh C). Use with caution in moderate impairment (Child-Pugh B). * **Renal Impairment:** No dose adjustment needed for CrCl ≥ 15 mL/min, but monitor closely in severe renal impairment. In ESRD patients on hemodialysis, manufacturer labeling suggests 5 mg twice daily (reduce to 2.5 mg if age/weight criteria met), though clinical practice varies by facility protocol. ## Contraindications * Active pathological bleeding. * Severe hypersensitivity to apixaban. ## Adverse Effects * **Major:** Hemorrhage (GI, intracranial, ocular). * **Common:** Anemia, contusion, nausea. * **Rare:** Hypersensitivity reactions, thrombocytopenia. ## Key Drug Interactions * **P-gp and Strong CYP3A4 Inhibitors:** (e.g., ketoconazole, ritonavir, clarithromycin) Increase apixaban exposure; avoid or reduce dose based on clinical protocol. * **P-gp and Strong CYP3A4 Inducers:** (e.g., rifampin, carbamazepine, phenytoin, St. John’s Wort) Decrease apixaban efficacy; avoid concomitant use. * **Anticoagulants/Antiplatelets/NSAIDs:** Increase risk of major bleeding. ## Monitoring * Renal function (baseline and periodically). * Signs and symptoms of bleeding (hemoglobin/hematocrit if major bleed suspected). * Liver function tests (if clinically indicated). * **Note:** Routine coagulation monitoring (PT/INR) is neither required nor reliable for assessing anticoagulant activity. ## Clinical Pearls * **Reversal:** Andexanet alfa is the specific reversal agent for life-threatening or uncontrolled bleeding, though availability is limited; follow local massive hemorrhage protocols. * **Missed Dose:** Take as soon as remembered on the same day; do not double the dose to compensate. * **Perioperative Management:** Discontinue at least 48 hours before elective surgery with high risk of bleeding, or 24 hours before procedures with low risk. * **Crushability:** Tablets may be crushed and suspended in water, D5W, or apple juice for NG tube administration. *** **Disclaimer:** This information is for educational purposes only. Always consult the most current official prescribing information (package insert) and institutional formulary/protocols before prescribing or administering medication. Dosage, indications, and safety data are subject to change.