Apixaban

Administration

• Type: Anticoagulant
• Dosage Forms: tablet
• Dosage Strengths: 2.5mg, 5mg
• Routes of Administration: Oral
• Common Trade Names: Eliquis

Adult Dosing

Pulmonary embolism, DVT

• 10mg PO twice daily x 7 days, then 5mg BID

Stroke prevention in afib

• 5mg PO BID. Reduce the dose to 2.5 mg PO BID if patient has any 2 of the following: Age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.

Post-op DVT prophylaxis after hip or knee arthroplasty

• 2.5mg BID

Pediatric Dosing

Safety/efficacy not established

Special Populations

• Pregnancy Rating: B
• Lactation risk: Infant risk cannot be ruled out
• Renal dosing: No adjustment for DVT/PE treatment. Afib: 2.5mg BID if creatinine >1.5
• Hepatic dosing: No adjustment for mild impairment. Not recommended if severe impairment.
• Decrease dose if concomitant use of CYP3A4 and P-gp efflux dual inhibitors

Contraindications

• Allergy to class/drug
• Active bleeding

Adverse Reactions

Serious

• Major bleeding (GI, muscular, epidural, intracranial, conjunctival, urinary, intraoperative)
  • • Bleeding, severe
      • Andexanet alfa
• LFT abnormalities

Common

• Easy bruising, hematoma, gingival bleeding, menorrhagia, epistaxis

Pharmacology

• Half-life: 7-16 hours
• Metabolism: Hepatic, mainly CYP3A4
• Excretion: 25% in urine and feces as metabolites; renal excretion accounts for 27%T of total clearance; biliary and direct intestinal excretion contributes to elimination in feces

Mechanism of Action

• Reversible factor Xa inhibitor→ decreased thrombin synthesis

See Also

• Andexanet alfa
• Anticoagulant reversal for life-threatening bleeds
• Procedures in patients with coagulopathies
• PE
• DVT