Direct Oral Factor Xa Inhibitor — VTE / AF Stroke Prevention 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-acting oral anticoagulant) used to prevent and treat venous thromboembolism and to prevent stroke 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.

Prescribing in practice

The main risk is bleeding, so it is contraindicated with active clinically significant haemorrhage and used cautiously with other antithrombotic drugs and in high bleeding-risk states.
It is not suitable for patients with mechanical heart valves or moderate-to-severe mitral stenosis.
Dose and suitability depend on renal function, age and weight, and exposure is altered by combined strong CYP3A4 and P-glycoprotein inhibitors or inducers.

Monitoring

Assess renal and hepatic function and bleeding risk before starting and at least annually, with no routine coagulation monitoring required.

Counselling the patient

Take regularly as prescribed and do not stop without advice, as this raises clot risk.
Report unusual bruising, bleeding or black stools, and tell other clinicians you take an anticoagulant.

Evidence & guidelines

The ARISTOTLE and AMPLIFY trials established apixaban's efficacy and favourable bleeding profile in atrial fibrillation and venous thromboembolism.

Reference: AMPLIFY Trial; ARISTOTLE Trial; NICE TA341 (Apixaban for VTE); NICE TA275 (Apixaban for AF); 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

Pathways