Apixaban

Anticoagulant, Direct factor Xa inhibitor, Direct oral anticoagulant (DOAC)

Apixaban

Eliquis

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Titration strategies

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Summary

Classes

Anticoagulant, Direct factor Xa inhibitor, Direct oral anticoagulant (DOAC)

Pharmacy

Starting dose

NVAF: 5 mg PO BID (2.5 mg BID if 2 of 3: age ≥80, weight ≤60 kg, serum creatinine ≥1.5 mg/dL); acute VTE: 10 mg BID for 7 days, then 5 mg BID

Preparations

2.5 mg, 5 mg tablets

US FDA Max

10 mg BID for the first 7 days of acute VTE; otherwise 5 mg BID

Pharmacology

Routes

Oral

Onset

Peak anticoagulant effect 3-4 hours

Duration

12 hours

Half-life

~12 hours

Bioavailability

~50% (oral; not significantly affected by food)

Pregnancy

Avoid in pregnancy; switch to LMWH. Crosses placenta; data are limited but warfarin-class concerns about fetal hemorrhage and possible teratogenicity make heparins the preferred class.^{[citation needed]}

Legal status

Rx-only in US

Purported mechanism

Apixaban is a selective reversible direct inhibitor of activated factor X (Xa); blocking Xa interrupts thrombin generation at a stoichiometrically efficient point in the coagulation cascade, producing predictable anticoagulation without routine monitoring.▲0▼ CYP3A4 (primary) and P-glycoprotein substrate; strong dual inhibitors or inducers materially shift exposure. Reversal: andexanet alfa for life-threatening bleeding; 4F-PCC commonly used off-label when andexanet unavailable.