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.
A DOAC is generally preferred over warfarin for nonvalvular AF and for most VTE because it needs no INR monitoring and has fewer food and drug interactions. Among DOACs, apixaban is often chosen for its lower bleeding rates and use in reduced kidney function. Avoid it with mechanical heart valves, triple-positive antiphospholipid syndrome, and severe hepatic impairment, and do not use it in place of heparin for hemodynamically unstable PE.
The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Doses come from the FDA label. Study tool, not for clinical decisions.
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Atrial fibrillation: reduce to 2.5 mg twice daily only when 2 of the 3 criteria apply (creatinine 1.5 mg/dL or more, age 80 or more, weight 60 kg or less). ESRD on hemodialysis: usual dose. VTE indications: no renal adjustment. Watch closely for bleeding.
Mild (Child-Pugh A): no change. Moderate (Child-Pugh B): no dosing recommendation because of limited experience and possible coagulation abnormalities. Severe (Child-Pugh C): not recommended.
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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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Andexanet alfa reverses apixaban's anti-factor Xa effect in adults. Prothrombin complex concentrate or factor VIIa are options, though unstudied. Activated charcoal soon after ingestion lowers absorption. Hemodialysis does little, and protamine and vitamin K are not expected to work. The effect lasts at least 24 hours after the last dose.
Human data are too limited to define risk. It can raise bleeding in the mother, fetus, and newborn, and neuraxial anesthesia at delivery risks spinal hematoma. Consider a shorter-acting anticoagulant as delivery nears.
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No human data, but it accumulates in rat milk. Breastfeeding is not recommended during treatment.
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Approved from birth for VTE after at least 5 days of initial anticoagulation, dosed by weight. Children 35 kg or more get adult tablets: 10 mg twice daily for days 1 to 7, then 5 mg twice daily. Not recommended below 2.6 kg or, from age 2, with eGFR below 30.