BLACK BOX WARNING
- premature discontinuation increases stroke risk
apixaban
Brand: Eliquis
⚠ BBW ISMP High Alert Prototype: rivaroxaban
Drug Class: anticoagulant
Drug Family: anticoagulant
Subclass: DOAC — direct factor Xa inhibitor
Organ Systems: cardiovascularhematology-oncology
Mechanism of Action
Direct competitive Xa inhibitor with predictable twice-daily PK; lowest GI bleeding risk among DOACs.
factor Xa (direct, competitive)
Indications
- AF stroke prevention
- DVT/PE treatment and prevention
- post-arthroplasty thromboprophylaxis
Contraindications
- severe hepatic impairment
- active major bleeding
- mechanical prosthetic valves
Adverse Effects
Common
- bleeding
- bruising
Serious
- major hemorrhage
Pharmacokinetics (ADME)
| Absorption | 50% oral bioavailability |
| Distribution | moderate |
| Metabolism | CYP3A4 (~25%), P-gp substrate |
| Excretion | fecal 27%, renal 25% |
| Half-life | 12 hours |
| Onset | 3-4 hours |
| Peak | 3-4 hours |
| Duration | 12 hours |
| Protein Binding | 87% |
| Vd | 21 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| strong CYP3A4/P-gp inhibitors | increases apixaban levels — reduce dose 50% | major |
| strong CYP3A4/P-gp inducers (rifampin) | reduces apixaban — avoid | major |
Nursing Considerations
- Twice-daily dosing: 10 mg BID x7 days then 5 mg BID for acute DVT/PE
- AF dose reduction criteria (any 2 of): creatinine >=1.5, age >=80, weight <=60 kg -> 2.5 mg BID
- Antidote: andexanet alfa (shared with rivaroxaban)
Clinical Pearls
- ARISTOTLE: superior to warfarin for AF stroke prevention with less major bleeding and all-cause mortality
- Lowest GI bleeding risk among all DOACs
- AMPLIFY: as effective as LMWH/warfarin for DVT/PE with less bleeding
Safety Profile
Pregnancy avoid
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.