Apixaban in Atrial Fibrillation
- Apixaban 5mg BD
Dose Adjustment
- Reduced dose of 2.5mg BD should be prescribed in patients who:
- Age ≥80 years
- Body weight ≤ 60kg
- Serum Creatinine ≥1.5mg/dL (133umol/L)
- OR have severe renal impairment (CrCl 15-29ml/min) alone
Apixaban in DVT/PE
- Day 1-7 = Apixaban 10mg BD
- Day 8+ = Apixaban 5mg BD (for at least 3 months)
- Extended Prophylactic dose = Apixaban 2.5mg BD
Dose Adjustment
- No dose adjustment required for age, weight, gender, or those with mild-moderate renal impairment
- Caution in patients with severe renal impairment (CrCl 15-29ml/min)
- Contraindicated in patents with CrCl <15ml/min, or in patients undergoing dialysis
Contraindications
Medications and conditions causing increased bleeding risk
- CrCl<15ml/min
- Patients undergoing dialysis
- Severe hepatic impairment
- Hepatic disease associated with coagulopathy and clinically relevant bleeding risk
- Concomitant use with other anticoagulants
- Strong CYP3A4 inhibitors (examples: ketoconazole, itraconazole, posaconazole, voriconazole, HIV protease inhibitors)
Cautions
Medications and conditions causing increased bleeding risk
- Severe renal impairment (CrCl 15-29ml/min)
- NSAIDs
- Antiplatelet agents
Medications that reduce efficacy of Apixaban
- Strong CYP3A4 inducers (examples: carbamazepine, phenytoin, phenobarbitone, rifampicin, St Johns Wort)
Missed Dose
- A missed morning dose should be taken immediately when it is noticed, and it may be taken together with the evening dose.
- A missed evening dose can only be taken during the same evening, the patient should not take two doses the next morning.
- The patient should continue with the intake of the regular dose twice daily as recommended on the following day.
Converting Anticoagulants
Warfarin to Apixaban
- Discontinue Warfarin
- Monitor daily INR until <2.0
- Start Apixaban BD
Parenteral Heparin/Another DOAC to Apixaban
- Discontinue Parenteral Heparin / Other DOAC
- Start Apixaban BD at the next scheduled dose
Thrombophlebitis
The use of Apixaban in the management of thrombphlebitis (NB dose = Apixaban 2.5mg BD x6/52) is off license but we believe the evidence supports it's use in patients with high risk thrombophlebitis. More on Thrombophlebitis.