Direct Oral Anticoagulant (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 an oral direct factor Xa inhibitor (a direct oral anticoagulant) used to prevent and treat venous thromboembolism and to reduce stroke risk in non-valvular atrial fibrillation.

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: Treatment of DVT and PE (VTEt): 10 mg twice daily for the first 7 days, followed by 5 mg twice daily. Prevention of recurrent DVT and PE: 2.5 mg twice daily. Prevention of VTE after elective hip/knee replacement (VTEp): 2.5 mg twice daily.

Route: Oral

Frequency: Twice daily

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

VTEt (treatment of acute DVT and PE): 10 mg twice daily for the first 7 days followed by 5 mg twice daily; short duration of treatment (at least 3 months) should be based on transient risk factors (e.g. recent surgery, trauma, immobilisation). Prevention of recurrent DVT and/or PE: 2.5 mg twice daily, initiated following completion of 6 months of treatment with apixaban 5 mg twice daily or another anticoagulant. 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). Duration of overall therapy should be individualised after assessment of treatment benefit against bleeding risk. 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 VTEt/VTEp. Severe renal impairment (CrCl 15-29 mL/min): use with caution. 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.

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)
Thrombocytopenia (common in VTEt)
Epistaxis (common)
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

It directly and reversibly inhibits activated factor Xa, reducing thrombin generation and clot formation without requiring antithrombin as a cofactor.

Prescribing in practice

Bleeding is the principal risk; it should be avoided in active clinically significant bleeding and used cautiously where bleeding risk is high, with andexanet alfa available as a specific reversal agent.
It is contraindicated in mechanical heart valves and not recommended in significant mitral stenosis or antiphospholipid syndrome, and dose adjustment applies in renal impairment and other defined criteria.
Combined strong inhibitors or inducers of both CYP3A4 and P-glycoprotein (e.g. azole antifungals, certain antivirals, rifampicin, some anticonvulsants) materially alter exposure and are generally avoided.

Monitoring

Monitor renal and hepatic function and full blood count periodically and review bleeding risk, rather than relying on routine coagulation assays.

Counselling the patient

Take it regularly as prescribed and do not stop abruptly without advice, as this raises clot risk.
Report unusual bruising, blood in urine or stool, or prolonged bleeding promptly.
Carry an anticoagulant alert card and tell any dentist or surgeon you take it.

Evidence & guidelines

Apixaban is recommended by NICE for atrial fibrillation and venous thromboembolism, with efficacy and safety established in the ARISTOTLE and AMPLIFY trials.

Reference: NICE TA275; AMPLIFY/ARISTOTLE trials; 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.

Calculators

Drugs

Rivaroxaban · Direct Oral Anticoagulant (Factor Xa Inhibitor)

Pathways