Apixaban

Apixaban Brand Name– Eliquis

What is Apixaban

Apixaban is an oral and selective factor Xa inhibitor anticoagulant indicated for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, for prevention of deep vein thrombosis (DVT) after hip or knee replacement surgery, for the treatment of DVT and pulmonary embolism (PE), and for the reduction in risk of recurrence of DVT and PE.

Apixaban carries a black box warning against abrupt discontinuation in patients with atrial fibrillation as well as for risk of spinal/epidural hematoma in patients undergoing neuraxial anesthesia or lumbar puncture. Use in patients with prosthetic heart valves is not recommended.

During clinical trials, the most common adverse events were related to bleeding.

Similar to rivaroxaban and dabigatran, apixaban has a rapid onset of effect and predictable anticoagulant effects; routine laboratory monitoring is not required.

When comparing apixaban to warfarin, limitations of warfarin such as the unpredictable and variable effect, narrow therapeutic window requiring routine INR monitoring, and numerous food and drug interactions contributing to poor compliance are not factors associated with apixaban therapy.

A reversal agent, factor Xa, is available when reversal of anticoagulation is necessary due to life-threatening or uncontrolled bleeding.

Indications

  1. atrial fibrillation
  2. deep venous thrombosis (DVT)
  3. deep venous thrombosis (DVT) prophylaxis
  4. pulmonary embolism
  5. pulmonary embolism prophylaxis
  6. stroke prophylaxis

Side Effects

  1. anaphylactoid reactions
  2. anemia
  3. bleeding
  4. elevated hepatic enzymes
  5. epistaxis
  6. GI bleeding
  7. hematemesis
  8. hematoma
  9. hematuria
  10. hemoptysis
  11. hyperbilirubinemia
  12. hypotension
  13. intracranial bleeding
  14. melena
  15. menorrhagia
  16. ocular hemorrhage
  17. rash
  18. spinal hematoma
  19. stroke
  20. syncope
  21. thrombocytopenia
  22. vaginal bleeding

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • abrupt discontinuation
  • antiphospholipid antibody syndrome
  • bleeding
  • breast-feeding
  • dialysis
  • epidural anesthesia
  • geriatric
  • hepatic disease
  • intramuscular injections
  • labor
  • lumbar puncture
  • obstetric delivery
  • pregnancy
  • prosthetic heart valves
  • renal failure
  • renal impairment
  • spinal anesthesia
  • surgery

Interactions

  • Abciximab
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Ado-Trastuzumab emtansine
  • Alteplase
  • Altretamine
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amiodarone
  • Amlodipine; Celecoxib
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Anagrelide
  • Antithrombin III
  • Antithymocyte Globulin
  • Apalutamide
  • Ardeparin
  • Arsenic Trioxide
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Betrixaban
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Caplacizumab
  • Carbamazepine
  • Carbenicillin
  • Celecoxib
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  • Cilostazol
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  • Enoxaparin
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  • Eptifibatide
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  • Garlic, Allium sativum
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  • Ginger, Zingiber officinale
  • Ginkgo, Ginkgo biloba
  • grapefruit juice
  • Green Tea
  • Hemin
  • Heparin
  • Hydrocodone; Ibuprofen
  • Hydroxyurea
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibritumomab Tiuxetan
  • Ibrutinib
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Icosapent ethyl
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  • Iloprost
  • Indomethacin
  • Inotersen
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Intravenous Lipid Emulsions
  • Isavuconazonium
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Itraconazole
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Lomustine, CCNU
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  • Low Molecular Weight Heparins
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  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
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  • Ticarcillin; Clavulanic Acid
  • Ticlopidine
  • Tinzaparin
  • Tirofiban
  • Tolmetin
  • Topiramate
  • Trandolapril; Verapamil
  • Trazodone
  • Treprostinil
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  • Verapamil
  • Verteporfin
  • Vilazodone
  • Vorapaxar
  • Vorinostat
  • Vortioxetine
  • Warfarin
  • Zonisamide
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