Apixaban
Brand names: Eliquis
Apixaban is a direct oral anticoagulant (a factor Xa inhibitor) used for stroke prevention in non-valvular atrial fibrillation and for the treatment and prevention of venous thromboembolism. It is given at fixed doses without routine coagulation monitoring.
Adult dose
Dose adjustments
Mild/moderate impairment: no dose adjustment for NVAF unless dose-reduction criteria met. Severe renal impairment (CrCl 15-29 mL/min): for NVAF give the lower dose 2.5 mg twice daily. CrCl < 15 mL/min or dialysis: not recommended (no clinical experience).
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 UK2 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 in NVAF)
- Eye haemorrhage including conjunctival haemorrhage (common in NVAF)
- Hypotension (common in NVAF); contusion; nausea
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
Apixaban directly and reversibly inhibits activated factor X (factor Xa), reducing thrombin generation and clot formation.
Prescribing in practice
- The dose depends on the indication and, for AF, on dose-reduction criteria (age, body weight and renal function) — check these before prescribing.
- Renal function affects dosing and suitability; avoid in severe renal impairment and review eGFR periodically (see the Renal Drug Dosing tool).
- No routine monitoring is needed, but adherence matters because of the short half-life; a specific reversal agent exists for life-threatening bleeding where available.
- Interacts with strong dual CYP3A4 and P-glycoprotein inhibitors or inducers — review co-medication.
Monitoring
No routine coagulation monitoring; check renal and hepatic function and full blood count before starting and periodically, and reassess during intercurrent illness.
Counselling the patient
- Take it regularly as prescribed — missing doses leaves you unprotected because it wears off quickly.
- Report unusual bleeding or bruising.
- Tell any clinician or dentist that you take an anticoagulant before procedures or new medicines.
Evidence & guidelines
DOACs are recommended first-line over warfarin for non-valvular AF in NICE NG196; apixaban's efficacy and bleeding profile in AF were shown in ARISTOTLE.
Reference: NICE NG196; ARISTOTLE trial; ESC AF Guidelines; 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).
Related
Curated clinical cross-links plus same-class fallbacks.
- ABC-Bleeding Score for Anticoagulated Atrial Fibrillation · Bleeding Risk
- GARFIELD-AF Risk Score for Atrial Fibrillation · Atrial Fibrillation
- DOAC Score for Selecting Direct Oral Anticoagulant in Non-Valvular AF · Anticoagulation
- ORBIT Bleeding Risk Score for Anticoagulation in AF Patients · Anticoagulation
Featured in these MRCEM clinical pathways
Apixaban is a core drug in the following exam-focused workups on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.