Drug Action
Apixaban is a direct inhibitor of activated factor X (factor Xa).
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Individual generic drug information
Extracted information for Apixaban only.
Apixaban is a direct inhibitor of activated factor X (factor Xa).
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Prophylaxis of venous thromboembolism following knee replacement surgery ▶BY MOUTH ▶Adult: 2.5 mg twice daily for 10–14 days, to be started 12–24 hours after surgery Prophylaxis of venous thromboembolism following hip replacement surgery ▶BY MOUTH ▶Adult: 2.5 mg twice daily for 32–38 days, to be started continued → 12–24 hours after surgery Treatment of deep-vein thrombosis | Treatment of pulmonary embolism ▶BY MOUTH ▶Adult: Initially 10 mg twice daily for 7 days, then Cardiovascular system maintenance 5 mg twice daily Prophylaxis of recurrent deep-vein thrombosis | Prophylaxis of recurrent pulmonary embolism ▶BY MOUTH ▶Adult: 2.5 mg twice daily, following completion of 6 months anticoagulant treatment Prophylaxis of stroke and systemic embolism in non- valvular atrial fibrillation and at least one risk factor (such as previous stroke or transient ischaemic attack, symptomatic heart failure, diabetes mellitus, hypertension, or age 75 years and over) ▶BY MOUTH ▶Adult: 5 mg twice daily, reduce dose to 2.5 mg twice daily in patients with at least two of the following characteristics: age 80 years and over, body-weight less than 61 kg, or serum creatinine 133 micromol/litre and over DOSE EQUIVALENCE AND CONVERSION ▶For information on changing from, or to, other anticoagulants, consult product literature.
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Active, clinically significant bleeding. antiphospholipid syndrome (increased risk of recurrent thrombotic events). risk factors for major bleeding CONTRA-INDICATIONS, FURTHER INFORMATION ▶Risk factors for major bleeding Manufacturer advises avoid in conditions with significant risk factors for major bleeding, including current or recent gastrointestinal ulceration, malignant neoplasms at high risk of bleeding, recent brain or spinal injury, recent brain, spinal or ophthalmic surgery, recent intracranial haemorrhage, known or suspected oesophageal varices, arteriovenous malformations, vascular aneurysms or major intraspinal or intracerebral vascular abnormalities.
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Anaesthesia with postoperative indwelling epidural catheter (risk of paralysis—monitor neurological signs and wait 20–30 hours after apixaban dose before removing catheter and do not give next dose until at least 5 hours after catheter removal). prosthetic heart valve (efficacy not established). risk of bleeding CAUTIONS, FURTHER INFORMATION ▶Elderly For factor Xa inhibitors, prescription potentially inappropriate (STOPP criteria): . with concurrent significant bleeding risk, such as uncontrolled severe hypertension, bleeding diathesis or recent non-trivial spontaneous bleeding (high risk of bleeding) . for first deep venous thrombosis without continuing provoking risk factors (e.g. thrombophilia) for greater than 6 months (no proven added benefit) . for first pulmonary embolus without continuing provoking risk factors for greater than 12 months (no proven added benefit) . as part of dual therapy with an antiplatelet agent in patients with stable coronary, cerebrovascular or peripheral arterial disease, without a clear indication for anticoagulant therapy (no added benefit) . if eGFR less than 15 ml/min/1.73 m2 (risk of bleeding) See also Prescribing in the elderly p. 33.
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Duration of treatment should be determined by balancing the benefit of treatment with the bleeding risk; shorter duration of treatment (at least 3 months) should be based on transient risk factors i.e recent surgery, trauma, immobilisation. Apixaban should not be used as an alternative to unfractionated heparin in pulmonary embolism in patients with haemodynamic instability, or who may receive thrombolysis or pulmonary embolectomy.
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NICE decisions ▶Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (January 2012) NICE TA245 Apixaban (Eliquis ®) is an option for the prevention of venous thromboembolism in adults after elective hip or knee replacement surgery. www.nice.org.uk/guidance/ta245 ▶Apixaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (February 2013) NICE TA275 Apixaban (Eliquis ®) is an option for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation in accordance with its licensed indication; with one or more of the following risk factors: . previous stroke or transient ischaemic attack . symptomatic heart failure . age 75 years . diabetes mellitus . hypertension. The risks and benefits of apixaban compared to warfarin, dabigatran etexilate, and rivaroxaban should be discussed with the patient. www.nice.org.uk/guidance/ta275 ▶Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (June 2015) NICE TA341 Apixaban (Eliquis ®) is an option for the treatment and prevention of recurrent deep vein thrombosis and pulmonary embolism in adults. www.nice.org.uk/guidance/ta341
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Extracted information for Apixaban only.
MHRA/CHM ADVICE: DIRECT-ACTING ORAL ANTICOAGULANTS (DOACS): INCREASED RISK OF RECURRENT THROMBOTIC EVENTS IN PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME (JUNE 2019) A clinical trial has shown an increased risk of recurrent thrombotic events associated with rivaroxaban compared with warfarin, in patients with antiphospholipid syndrome and a history of thrombosis. There may be a similar risk associated with other DOACs. Healthcare professionals are advised that DOACs are not recommended in patients with antiphospholipid syndrome, particularly high-risk patients who test positive for all three antiphospholipid tests—lupus anticoagulant, anticardiolipin antibodies, and anti-beta2 glycoprotein I antibodies. Continued treatment should be reviewed in these patients to determine if appropriate, and switching to a vitamin K antagonist such as warfarin should be considered.
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→Appendix 1: apixaban
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▶Common or very common Anaemia. haemorrhage. nausea. skin reactions ▶Uncommon CNS haemorrhage. hypotension. post procedural haematoma. thrombocytopenia. wound complications
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Manufacturer advises avoid—no information available.
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Manufacturer advises avoid—present in milk in animal studies.
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Manufacturer advises caution in mild to moderate impairment (or if hepatic transaminases greater than 2 times the upper limit of normal, or if bilirubin is equal or greater than 1.5 times the upper limit of normal); avoid in severe impairment or impairment associated with coagulopathy and clinically relevant bleeding risk.
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Manufacturer advises avoid if creatinine clearance less than 15 mL/minute—no information available. When used for prophylaxis of venous thromboembolism following knee or hip replacement surgery, prophylaxis of recurrent deep-vein thrombosis or pulmonary embolism, and treatment of deep-vein thrombosis or pulmonary embolism, use with caution if creatinine clearance 15–29 mL/minute. Dose adjustments When used for prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation, reduce dose to 2.5 mg twice daily if serum-creatinine 133 micromol/litre and over is associated with age 80 years and over or body-weight less than 61 kg; reduce dose to 2.5 mg twice daily if creatinine clearance 15–29 mL/minute.
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▶Patients should be monitored for signs of bleeding or anaemia; treatment should be stopped if severe bleeding occurs. ▶No routine anticoagulant monitoring required (INR tests are unreliable).
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Extracted information for Apixaban only.
There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 10 ▶Eliquis (Bristol-Myers Squibb Pharmaceuticals Ltd) Apixaban 2.5 mg Eliquis 2.5mg tablets | 10 tablet P £9.50 | 20 tablet P £19.00 | 60 tablet P £57.00 DT = £57.00 Apixaban 5 mg Eliquis 5mg tablets | 28 tablet P £26.60 | 56 tablet P £53.20 DT = £53.20
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Extracted information for Apixaban only.
Patients should be provided with an alert card and advised to keep it with them at all times.
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Filter the extracted dose blocks for this individual drug.
First line only; read the complete Indications and dose section above.
2.5 mg twice daily for 10–14 days, to be started
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 155
First line only; read the complete Indications and dose section above.
2.5 mg twice daily for 32–38 days, to be started
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 155
First line only; read the complete Indications and dose section above.
Initially 10 mg twice daily for 7 days, then
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 156
First line only; read the complete Indications and dose section above.
2.5 mg twice daily, following completion of
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 156
First line only; read the complete Indications and dose section above.
5 mg twice daily, reduce dose to 2.5 mg twice
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 156