Known brand names include Eliquis.
An oral blood thinner (a direct factor Xa inhibitor) taken twice a day. It lowers stroke risk in atrial fibrillation not caused by valve disease, prevents clots after hip or knee replacement, and treats and prevents DVT and PE. No routine blood tests are needed.
Apixaban blocks factor Xa, a protein near the end of the clotting process, whether it is floating free or already caught up in a clot. It does this directly, without needing help from other proteins in the blood. With factor Xa blocked, the body makes less thrombin, so clots form and grow less. It has no direct effect on platelets, though it indirectly lessens the platelet clumping that thrombin sets off.
Blood levels peak 3 to 4 hours after a dose, and the body clears half of it in about 12 hours. Its effect lasts at least 24 hours after the last dose. Because it slows clotting, it raises the risk of bleeding, which can be serious or fatal, and a drug that reverses it is available for adults. Stopping it early without switching to another blood thinner raises the risk of clots and stroke.
Apixaban is a blood thinner taken as a pill. In adults with atrial fibrillation, an irregular heartbeat that can lead to clots and stroke, it lowers the chance of a stroke or of a clot traveling elsewhere in the body when the irregular rhythm is not due to a heart valve problem. It also treats deep vein thrombosis, a clot usually in the leg, and pulmonary embolism, a clot in the lung, and then lowers the chance they come back. After hip or knee replacement surgery, it helps prevent leg clots that could travel to the lungs.
Adults take it by mouth, with or without food. In children from birth onward, it treats clots in the veins and lowers the chance they return, once they have had at least 5 days of other blood-thinning treatment. It is not recommended for people with artificial heart valves.
Bleeding is the most common side effect: bruising, nosebleeds, bleeding gums, blood in the urine, and heavier periods. Children may also have headache and vomiting. The label treats major bleeding as the main danger, along with bleeding around the spine during spinal procedures, stroke or clots after stopping too early, and serious allergic reactions.
This is the boxed warning, the warning the FDA label prints first.
Two warnings. (A) Stopping early raises the risk of clots and stroke; if it is stopped for any reason other than pathological bleeding or a finished course, cover with another anticoagulant. (B) Spinal or epidural hematoma, which can cause long-term or permanent paralysis, may occur with neuraxial anesthesia or spinal puncture. Risk rises with indwelling epidural catheters, other drugs affecting hemostasis, traumatic or repeated punctures, and prior spinal deformity or surgery. Monitor neurologic status often.
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