Anticoagulant Pregnancy: Contraindicated — no safety data; crosses placenta; use LMWH

Apixaban

Brand names: Eliquis

Adult dose

Dose: AF stroke prevention: 5mg BD. VTE treatment: 10mg BD × 7 days, then 5mg BD

Route: Oral

Frequency: Twice daily

Max: 10mg BD (treatment phase)

AF: reduce to 2.5mg BD if ≥2 of: age ≥80, weight ≤60kg, creatinine ≥133 micromol/L. VTE extended: 2.5mg BD after ≥6 months treatment. Pulmonary embolism: 10mg BD × 7 days, then 5mg BD × 6 months minimum.

Dose adjustments

Renal

CrCl 15–29 ml/min: consider dose reduction. CrCl <15 ml/min or dialysis: avoid (limited data).

Hepatic

Avoid in severe hepatic impairment (Child-Pugh C) or coagulopathy.

Clinical pearls

ARISTOTLE trial: apixaban vs warfarin in AF — 21% reduction in stroke/SE, 31% reduction in major bleeding, 11% reduction in all-cause mortality.
Reversal agent: andexanet alfa (Ondexxya) for life-threatening bleeding. Alternatively: 4-factor PCC 25–50 units/kg (unlicensed).
Half-life ~12h — no monitoring required in standard use. Ensure twice-daily compliance.
Renal dose reduction criteria (2.5mg BD in AF): two or more of — age ≥80, weight ≤60kg, creatinine ≥133 micromol/L.

Contraindications

Active major haemorrhage
Mechanical prosthetic heart valves (DOACs contraindicated)
Antiphospholipid syndrome with triple positivity
Significant hepatic impairment with coagulopathy
CrCl <15 ml/min

Side effects

Bleeding (major: 2.1%/year in ARISTOTLE — less than warfarin)
Anaemia
Nausea
Bruising

Interactions

Strong CYP3A4 and P-gp inhibitors (ketoconazole, ritonavir): increase apixaban — avoid combination
Strong CYP3A4 and P-gp inducers (rifampicin, carbamazepine, phenytoin): reduce apixaban — avoid
Aspirin / NSAIDs: additive bleeding risk

Monitoring

No routine coagulation monitoring required. Annual eGFR and LFTs. Hb if bleeding suspected.

Reference: ARISTOTLE Trial NEJM 2011; NICE TA275 (AF); NICE TA341 (VTE); NICE BNF 84. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Same class