Makindo Medical Notes.com

Indicated in non-rheumatic AF with one of the following previous stroke or transient ischaemic attack, CCF, age > 75 years, diabetes mellitus or hypertension

About: Always check the BNF link here

• Prevent stroke/systemic embolism in non-valvular AF with additional risk factor

Action

• Direct Factor Xa inhibitor metabolized mainly by CYP3A4

Studies

• Aristotle Study vs Warfarin
• Averroes Study vs Aspirin

Indications

• 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.

Interactions

• 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

Cautions

• Other Anticoagulants and antithrombotic drugs or coagulopathy
• 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

Contraindications

• 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

Side effects

• 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)

References

• Apixaban in BNF