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Apixaban
๐ Apixaban is a direct oral anticoagulant (DOAC) used to prevent stroke and systemic embolism in non-valvular atrial fibrillation (AF) with additional risk factors (previous stroke/TIA, CCF, age >75, diabetes, hypertension). โ ๏ธ Always check the BNF link here for the most up-to-date prescribing guidance.
๐ About
- Direct Factor Xa inhibitor โ blocks clot formation at a key step of the coagulation cascade.
- Metabolised mainly by CYP3A4.
- Oral, fixed dose, no INR monitoring needed โ .
- Well-studied in large RCTs vs warfarin and aspirin.
๐ Landmark Trials
- ARISTOTLE trial: Apixaban vs Warfarin โ lower bleeding, reduced stroke/systemic embolism, and lower mortality.
- AVERROES trial: Apixaban vs Aspirin โ significant reduction in stroke/systemic embolism without a big rise in major bleeding.
๐ Indications & Dosing
- Non-valvular AF: - Standard: 5 mg BD (ages 18โ79). - Reduce to 2.5 mg BD if โฅ2 of: age โฅ80, weight โค60 kg, creatinine โฅ133 ฮผmol/L.
- DVT/PE treatment: 10 mg BD for 7 days, then 5 mg BD for 6 months. May continue longer in high-risk patients.
- VTE prophylaxis post-op: - Knee replacement: 2.5 mg BD for 14 days, start 12โ24h post-op. - Hip replacement: 2.5 mg BD for 35 days, start 12โ24h post-op.
๐ Interactions
- Reduced effect with enzyme inducers: Carbamazepine, Phenytoin, Rifampicin, St Johnโs Wort, Dexamethasone.
- Increased bleeding risk with: warfarin, other anticoagulants, antiplatelets, NSAIDs.
โ ๏ธ Cautions
- High HAS-BLED score or poorly controlled hypertension.
- Other anticoagulants or coagulopathy โ โ bleeding risk.
- Stop 48h before surgery (if high bleeding risk) or 24h (if low bleeding risk).
- Avoid in pregnancy and breastfeeding.
โ Contra
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