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Direct Oral Anticoagulant (Factor Xa Inhibitor) Pregnancy: D

Apixaban

Brand names: Eliquis

Adult dose

Dose: 10 mg twice daily × 7 days then 5 mg twice daily (VTE treatment); 2.5 mg twice daily (prophylaxis or AF with two risk factors)
Route: oral
Frequency: twice daily
Max: 10 mg twice daily (initial VTE treatment); 5 mg twice daily (maintenance)
No food requirement; reduce AF dose to 2.5 mg BD if ≥2 of: age ≥80, weight ≤60 kg, creatinine ≥133 micromol/L

Paediatric dose

Route: oral
Frequency: twice daily
Max: Weight-based
Concentration: can be crushed and given with water mg/ml
Licensed ≥2 years for VTE treatment — weight-band dosing; see SPC for full table

Dose adjustments

Renal

Reduce AF dose (2.5 mg BD) if creatinine ≥133 + ≥1 criterion; avoid if eGFR <15 ml/min

Hepatic

Avoid in severe hepatic impairment

Clinical pearls

  • AMPLIFY trial: superior to enoxaparin/warfarin for VTE treatment with significantly less major bleeding
  • ARISTOTLE trial: superior to warfarin in AF — reduced stroke, major bleeding, and mortality
  • Reversal: andexanet alfa (FDA/EMA approved)

Contraindications

  • Clinically significant active bleeding
  • Hepatic disease with coagulopathy
  • eGFR <15 ml/min
  • Prosthetic heart valves (mechanical)

Side effects

  • Bleeding
  • Anaemia
  • Nausea
  • Elevated LFTs
  • Bruising

Interactions

  • Combined P-gp and strong CYP3A4 inhibitors (azoles, ritonavir — halve dose or avoid)
  • Combined inducers (rifampicin — avoid)
  • NSAIDs (increased bleeding)

Monitoring

  • Renal function annually
  • Signs of bleeding
  • FBC

Reference: BNFc; BNF 86; NICE TA275; AMPLIFY/ARISTOTLE trials. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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