Direct oral anticoagulant (DOAC) — Factor Xa inhibitor
Pregnancy: Contraindicated — LMWH preferred in pregnancy.
Apixaban
Brand names: Eliquis
Adult dose
Dose: AF: 5 mg twice daily (2.5 mg BD if ≥2 of: age ≥80, weight ≤60 kg, creatinine ≥133 micromol/L); VTE: 10 mg BD for 7 days then 5 mg BD
Route: Oral
Frequency: Twice daily
Max: 10 mg twice daily (VTE initial); 5 mg twice daily (maintenance/AF)
AF (ARISTOTLE criteria): 5 mg BD; reduce to 2.5 mg BD if 2 or more of age ≥80, weight ≤60 kg, creatinine ≥133 mcmol/L. VTE: 10 mg BD for 7 days, then 5 mg BD (maintenance) or 2.5 mg BD (extended treatment). Post-arthroplasty: 2.5 mg BD for 32–38 days (hip) or 10–14 days (knee).
Paediatric dose
Route: Oral
Frequency: Twice daily
Max: Specialist guidance required
Paediatric VTE: specialist haematology guidance required. Weight-based dosing. Licensed in some paediatric VTE scenarios.
Dose adjustments
Renal
Reduce to 2.5 mg BD if AF + 2 criteria (age ≥80, weight ≤60 kg, creatinine ≥133). Avoid if eGFR <15.
Hepatic
Avoid in moderate-severe hepatic impairment.
Clinical pearls
- Lowest GI bleeding risk among DOACs — preferred over rivaroxaban and dabigatran for GI bleeding risk
- Twice-daily dosing provides more stable drug levels — better adherence essential
- Can be crushed and dissolved in water (or apple juice) for administration via NG tube
- ARISTOTLE trial: apixaban superior to warfarin for AF — fewer strokes, fewer bleeds, lower mortality
- Reversal: andexanet alfa or 4-factor PCC
Contraindications
- Active significant bleeding
- Severe hepatic impairment
- Pregnancy
Side effects
- Bleeding (less GI bleeding than rivaroxaban or warfarin — ARISTOTLE trial)
- Anaemia
- Nausea
- Elevated LFTs
Interactions
- Strong CYP3A4 and P-gp inhibitors — increase apixaban levels
- Strong CYP3A4 and P-gp inducers — reduce apixaban levels
- Antiplatelet drugs and NSAIDs — increased bleeding
Monitoring
- eGFR annually
- LFTs
- Haemoglobin
- Signs of bleeding
Reference: BNFc; BNF; NICE NG196; ARISTOTLE trial; ESC AF Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Same class
- 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
Drugs
Same class
Pathways
Same specialty