II. Mechanism
- Oral direct Xa inhibitor
- Factor Xa is the first step in the Common Clotting Cascade
III. Indications
- Venous Thromboembolism or its prophylaxis
- Heparin Induced Thrombocytopenia (not FDA approved)
- Nonvalvular Atrial Fibrillation (stroke prevention with CHADS Score 2 or more)
- First-line alternative to Warfarin
- Poor INR control on Warfarin
- Barriers to INR monitoring
- Warfarin Drug Interactions
IV. Contraindications
- Acute bleeding
- Initial studies suggest less bleeding risk than Warfarin
-
Mechanical Heart Valves or valvular Atrial Fibrillation
- Use Warfarin instead
- Moderate to severe hepatic Impairment
- Pregnancy or Lactation
V. Precautions
-
Emergent Reversal of Anticoagulation (e.g. Hemorrhage)
- Andexxa released in 2018
- Consider Prothrombin Complex Concentrate, activated PCC or recombinant Factor VIIa
- Increased stroke risk if stopped abruptly without other Anticoagulation in nonvalvular Atrial Fibrillation
VI. Pharmacokinetics
- Half-Life: 8-15 hours (12 hour mean)
- Oral Bioavailability: 58%
- Onset: 3-4 hours
VII. Dosing: Atrial Fibrillation
- Standard dose
- Apixaban (Eliquis) 5 mg twice daily
- Half-dose indications (2.5 mg twice daily)
- See Renal Dosing below
VIII. Dosing: Venous Thromboembolism
- Renal Dosing does not apply
-
Venous Thromboembolism Treatment
- Initial: 10 mg orally twice daily for 7 days
- Maintenance: 5 mg orally twice daily
- Prevention of recurrence: 2.5 mg orally twice daily
-
Venous Thromboembolism Prophylaxis after Surgery
- Hip Replacement: 2.5 mg orally twice daily for 35 days
- Knee Replacement: 2.5 mg orally twice daily for 12 days
- Acute Heparin Induced Thrombocytopenia (not FDA approved)
- Take 5 mg orally twice daily (until Platelet Counts return to normal)
- If thrombosis is present, start with 10 mg orally twice daily for 1 week
IX. Dosing: Renal Dosing Indications
- Applies only to Atrial Fibrillation (not to Venous Thromboembolism)
-
Renal Dosing (2.5 mg orally twice daily) is indicated if at least 2 of the following criteria are present
- Serum Creatinine >=1.5 mg/dl or higher
- Age >=80 years old
- Weight <=60 kg (or <132 lb)
- References
X. Drug Interactions
- Strong Cytochrome P450 3A4 inducers
- Rifampin (also induces P-Glycoprotein)
- Phenytoin
- Carbamazepine
- Phenobarbital
- P-Glycoprotein Inhibitors
- Other Anticoagulants and antiplatelet agents
- Aspirin and other antiplatelet agents (e.g. Clopidogrel)
- NSAIDs
XI. Safety
- Unknown Safety in Pregnancy
- Unknown Safety in Lactation
XII. Resources
Images: Related links to external sites (from Bing)
Related Studies
| eliquis (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ELIQUIS 2.5 MG TABLET | $8.47 each | |
| ELIQUIS 5 MG TABLET | $8.46 each | |
| ELIQUIS DVT-PE TREATMENT 30-DAY STARTER 5 MG PACK | $8.47 each | |