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Eliquis
apixaban
Black Box Warnings .
Premature Tx Discontinuation
incr. thrombotic event risk when D/C apixaban for reasons other than pathological bleeding or completion of therapy course; if must D/C apixaban, consider administering another anticoagulant
Epidural/Spinal Hematoma Risk
epidural/spinal hematoma risk after epidural/spinal anesthesia or spinal puncture in anticoagulated pts; hematoma may result in long-term or permanent paralysis; incr. risk if indwelling epidural catheter use, concomitant use of drugs affecting hemostasis incl. NSAIDs, platelet inhibitors, or other anticoagulants, traumatic or repeated epidural or spinal puncture hx, spinal deformity, or spinal surgery hx; monitor s/sx neurologic impairment, treat urgently if needed; consider benefit vs. risk before neuraxial intervention in anticoagulated pts or planned anticoagulation for thromboprophylaxis
Adult Dosing .
Dosage forms: TAB: 2.5 mg, 5 mg
thromboembolism/stroke prevention
- [5 mg PO bid]
- Info: for non-valvular atrial fibrillation w/o moderate-severe mitral stenosis or mechanical heart valve; decr. dose to 2.5 mg PO bid if at least 2 of the following: 80 yo or older, wt <60 kg, Cr >1.5; to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >25 or 2-5 days if CrCl <25; resume tx >24h postop
DVT prophylaxis
- [hip replacement]
- Dose: 2.5 mg PO bid x35 days; Start: 12-24h postop
- [knee replacement]
- Dose: 2.5 mg PO bid x12 days; Start: 12-24h postop
DVT/PE prophylaxis, recurrent
- [2.5 mg PO bid]
- Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >25 or 2-5 days if CrCl <25; resume tx >24h postop
DVT/PE tx
- [10 mg PO bid x7 days, then 5 mg PO bid]
- Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >25 or 2-5 days if CrCl <25; resume tx >24h postop
VTE prophylaxis, cardioversion (off-label)
- [afib/flutter duration <48h]
- Dose: 5 mg PO bid; Start: ASAP before or immediately after cardioversion; Info: for pts w/ CHA2DS2-VASc score >2; continue tx for at least 4wk after procedure; refer to ACC/AHA/HRS guidelines
- [afib/flutter duration >48h or unknown]
- Dose: 5 mg PO bid; Start: at least 3wk before cardioversion; Info: continue tx for at least 4wk after procedure; refer to ACC/AHA/HRS guidelines
renal dosing
- [thromboembolism/stroke prophylaxis]
- Cr <1.5: 2.5 mg bid if also both wt <60 kg and 80 yo or older; Cr >1.5: 2.5 mg bid if also wt <60 kg and/or 80 yo or older; CrCl <15: not defined
- HD: 2.5 mg bid if also wt <60 kg and/or 80 yo or older; no supplement after dialysis; PD: not defined
- [VTE prophylaxis, cardioversion]
- renal impairment: not defined
- HD/PD: not defined
- [all other indications]
- renal impairment: no adjustment
- HD: no adjustment; no supplement; PD: not defined
hepatic dosing
- [see below]
- Child-Pugh Class A: no adjustment; Child-Pugh Class B: not defined; Child-Pugh Class C: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.