Indicated in non-rheumatic AF with one of the following previous stroke or transient ischaemic attack, CCF, age > 75 years, diabetes mellitus or hypertension
- Prevent stroke/systemic embolism in non valvular AF with additional risk factor
- Direct Factor Xa inhibitor metabolized mainly by CYP3A4
- Aristotle Study vs Warfarin
- Averroes Study vs Aspirin
- Non valvular AF: Adult 18 to 79 years 5 mg BD.
- Non valvular AF: Reduce dose if 2 out of 3 of following Age > 80 or Weight < 61 kg or Creatinine > 133 mmol/L then Apixaban 2.5 mg BD.
- DVT/PE: Apixaban 10 mg BD for 7 days, then maintenance 5 mg BD for 6 months.
- VTE prophylaxis: following knee replacement surgery Apixaban 2.5 mg BD for 14 days, to be started 12 to 24 hours after surgery.
- VTE prophylaxis:Following hip replacement surgery Apixaban 2.5 mg BD for 35 days, to be started 12 to 24 hours after surgery.
- Following should not be used with Apixaban as they reduce its effect
- Carbamazepine, Dexamethasone, Fosphenytoin
- Phenytoin, prothrombin complex concentrate
- Rifabutin, rifampin, St john's wort, Warfarin
- Other Anticoagulants and antithrombotic drugs or coagulaopathy
- High HAS BLED score, Poorly controlled BP
- Stop at least 48 hr before elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding.
- Stop at least 24 hr before elective surgery or invasive procedures with a low risk of unacceptable or where the bleeding would be non critical in location and easily controlled
- Avoid in pregnancy or lactation
- Renal or Liver failure, Active pathological bleeding
- Severe hypersensitivity reaction
- Significant risk of major bleeding: GI ulcer, oesophageal varices
- Recent brain, spine, or ophthalmic surgery
- Recent intracranial haemorrhage, malignant neoplasms, vascular aneurysm
- Bleeding - see below, Hypersensitivity reactions - rash and anaphylaxis, syncope
Bleeding Risk in two studies
- Fatal (0.06%, Warfarin 0.24%) (0.16%, Aspirin 0.16%)
- Major (2.13%, Warfarin 3.09% SIG) (1.41%, Aspirin 0.92% SIG)
- GI (0.83%, Warfarin 0.93%)
- Intracranial (0.33%, Warfarin 0.82% ) Intracranial (0.34%, Aspirin 0.35%)
- Clinically relevant non major bleeding (2.08%, Warfarin 3.0% SIG)