Direct Oral Anticoagulant (DOAC) — Factor Xa Inhibitor Pregnancy: No data in pregnant women; as a precautionary measure preferable to avoid use during pregnancy. Breast-feeding: a risk to the suckling child cannot be excluded.

Apixaban

Brand names: Eliquis

Apixaban is a direct oral anticoagulant (DOAC) — a factor Xa inhibitor — for atrial-fibrillation stroke prevention and for VTE treatment and prevention.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Indication-dependent. NVAF (stroke/systemic embolism prevention): 5 mg twice daily. VTE prophylaxis after elective hip/knee replacement (VTEp): 2.5 mg twice daily. Treatment of DVT/PE (VTEt): 10 mg twice daily for the first 7 days, then 5 mg twice daily; prevention of recurrent DVT/PE: 2.5 mg twice daily.

Route: Oral

Frequency: Twice daily

Max: 20 mg daily (10 mg twice daily) during first 7 days of DVT/PE treatment

VTEp (elective hip or knee replacement): 2.5 mg twice daily, initial dose 12-24 hours after surgery; duration 32-38 days (hip) or 10-14 days (knee). NVAF: 5 mg twice daily long-term; DOSE REDUCTION to 2.5 mg twice daily if at least TWO of: age >= 80 years, body weight <= 60 kg, or serum creatinine >= 1.5 mg/dL (133 micromole/L). VTEt (treatment of acute DVT and PE): 10 mg twice daily for first 7 days followed by 5 mg twice daily; short treatment duration (at least 3 months) based on transient risk factors. Prevention of recurrent DVT and PE: 2.5 mg twice daily, initiated after completion of 6 months of treatment with apixaban 5 mg twice daily or another anticoagulant. Combined P-gp and strong CYP3A4 inhibitors: reduce dose by 50% for patients on 5 mg or 10 mg twice daily; avoid if on 2.5 mg twice daily.

Dose adjustments

Renal

Mild/moderate impairment: no dose adjustment for VTEp/VTEt; for NVAF only if dose-reduction criteria met. Severe renal impairment (CrCl 15-29 mL/min): VTEp/VTEt use with caution; NVAF give lower dose 2.5 mg twice daily. CrCl < 15 mL/min or dialysis: not recommended.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

2 DOSAGE & ADMINISTRATION Reduction of risk of stroke and systemic embolism in nonvalvular atrial fibrillation: The recommended dose is 5 mg orally twice daily. ( 2.1 ) In patients with at least 2 of the following characteristics: age greater than or equal to 80 years, body weight less than or equal to 60 kg, or serum creatinine greater than or equal to 1.5 mg/dL, the recommended dose is 2.5 mg orally twice daily. ( 2.1 ) Prophylaxis of DVT following hip or knee replacement surgery: The recommended dose is 2.5 mg orally twice daily. ( 2.1 ) Treatment of DVT and PE: The recommended dose is 10 mg taken orally twice daily for 7 days, followed by 5 mg taken orally twice daily. ( 2.1 ) Reduction …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2021-06-15. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Active clinically significant bleeding
Hepatic disease associated with coagulopathy and clinically relevant bleeding risk
Lesion or condition considered a significant risk factor for major bleeding (e.g. current/recent GI ulceration, malignant neoplasms at high risk of bleeding, recent brain/spinal injury, recent brain/spinal/ophthalmic surgery, recent intracranial haemorrhage, known/suspected oesophageal varices, arteriovenous malformations, vascular aneurysms, major intraspinal or intracerebral vascular abnormalities)
Concomitant treatment with any other anticoagulant agent (e.g. UFH, low molecular weight heparins, heparin derivatives, oral anticoagulants) except under specific circumstances of switching anticoagulant therapy or catheter maintenance/ablation

Side effects

Haemorrhage, haematoma (common)
Anaemia (common)
Epistaxis (common)
Contusion
Nausea; thrombocytopenia (common in VTEt)

Interactions

Other anticoagulants — concomitant use contraindicated (increased bleeding risk)
Antiplatelet agents (including acetylsalicylic acid) — increase risk of bleeding
SSRIs / SNRIs and NSAIDs — take care due to bleeding risk
Combined P-gp and strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) — increase apixaban exposure; reduce dose by 50% (or avoid if on 2.5 mg BD)
Combined P-gp and strong CYP3A4 inducers — decrease apixaban exposure; avoid concomitant use

Clinical monograph

How it works

It directly and reversibly inhibits activated factor X (Xa), reducing thrombin generation.

Prescribing in practice

It needs no routine coagulation monitoring, but the dose depends on the indication and on criteria (age, weight, renal function — the reduced-dose AF criteria).
Avoid in severe renal impairment and in significant hepatic impairment with coagulopathy; bleeding is the main risk (specific reversal with andexanet alfa where available).
It is taken twice daily — adherence matters.

Monitoring

Monitor renal and hepatic function periodically and the full blood count; watch for bleeding.

Counselling the patient

Take it regularly, twice a day.
Report any bleeding or black stools.
Tell clinicians you take it before surgery or dental work.

Evidence & guidelines

At least as effective as warfarin for AF with less intracranial bleeding (ARISTOTLE; NICE NG196).

Reference: NICE NG196 (Atrial Fibrillation); ARISTOTLE Trial (NEJM 2011); MHRA DOAC Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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