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## Overview
Apixaban (Eliquis) is an oral, direct, and selective Factor Xa inhibitor.
## Primary Indications
* Stroke and systemic embolism prophylaxis in patients with non-valvular atrial fibrillation (NVAF).
* Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).
* Prophylaxis of DVT and PE in patients who have undergone hip or knee replacement surgery.
## Adult Dosing
* **NVAF:** 5 mg orally twice daily.
* **DVT/PE Treatment:** 10 mg orally twice daily for 7 days, followed by 5 mg orally twice daily.
* **DVT/PE Prophylaxis (post-op):** 2.5 mg orally twice daily, starting 12-24 hours after surgery. Duration depends on surgical procedure and patient risk.
## Pediatric Dosing
Dosing is weight-based and is established in specific age groups. Consult product labeling or pediatric guidelines for precise dosing.
## Dose Adjustments
Reduce dose to 2.5 mg orally twice daily if **two or more** of the following criteria are met:
* Age \>= 80 years
* Body weight \<= 60 kg
* Serum creatinine \>= 1.5 mg/dL
No dose adjustment is needed for mild to moderate hepatic impairment. Avoid use in severe hepatic impairment.
## Contraindications
* Active clinically significant bleeding.
* History of hypersensitivity to apixaban or any component of the formulation.
## Adverse Effects
* **Major Bleeding:** The most common and serious adverse effect.
* Bruising, epistaxis, gastrointestinal hemorrhage.
* Anemia.
## Key Drug Interactions
* **Strong CYP3A4 and P-glycoprotein (P-gp) inducers (e.g., rifampin):** May decrease apixaban exposure and efficacy. Consider alternatives.
* **Strong CYP3A4 and P-gp inhibitors (e.g., ketoconazole, itraconazole):** May increase apixaban exposure. Monitor closely for bleeding.
* **Other anticoagulants and antiplatelets:** Increased risk of bleeding. Use with caution and monitor closely.
## Monitoring
* No routine laboratory monitoring of anticoagulation is required.
* Monitor for signs and symptoms of bleeding.
* Assess renal function periodically.
## Clinical Pearls
* Apixaban does not typically require bridging with parenteral anticoagulants when initiating or discontinuing therapy, except in specific high-risk situations or based on local protocols.
* If mechanical heart valves are present, apixaban is contraindicated.
* Switching from or to other anticoagulants requires careful consideration of timing to avoid periods of inadequate or excessive anticoagulation.
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*Disclaimer: This information is intended for clinical pharmacists and healthcare professionals. It is essential to consult the most current official prescribing information and relevant clinical guidelines for complete details and to verify dosage and safety information before prescribing or dispensing.*
