II. Mechanism

  1. Oral direct Xa inhibitor
  2. Factor Xa is the first step in the Common Clotting Cascade

III. Indications : Nonvalvular Atrial Fibrillation (stroke prevention with CHADS Score 2 or more)

  1. Alternative to Warfarin (where Pradaxa Dyspepsia not tolerated)
  2. Poor INR control on Warfarin
  3. Barriers to INR monitoring
  4. Warfarin Drug Interactions

IV. Contraindications

  1. Acute bleeding
    1. Initial studies suggest less bleeding risk than Warfarin
  2. Mechanical Heart Valves or valvular Atrial Fibrillation
    1. Use Warfarin instead
  3. Moderate to severe hepatic Impairment
  4. Pregnancy or Lactation

V. Precautions

  1. No antidote for bleeding
    1. Consider Prothrombin Complex Concentrate, activated PCC or recombinant factor VIIa
  2. Increased stroke risk if stopped abruptly without other Anticoagulation in nonvalvular Atrial Fibrillation

VI. Pharmacokinetics

  1. Half-life: 8-15 hours (12 hour mean)
  2. Oral bioavailability: 58%
  3. Onset: 3-4 hours

VII. Dosing: Atrial Fibrillation

  1. Standard dose
    1. Apixaban (Eliquis) 5 mg twice daily
  2. Half-dose indications (2.5 mg twice daily)
    1. See Renal Dosing below

VIII. Dosing: Venous Thromboembolism

  1. Venous Thromboembolism Treatment
    1. Initial: 10 mg orally twice daily for 7 days
    2. Maintenance: 5 mg orally twice daily
    3. Prevention of recurrence: 2.5 mg orally twice daily
  2. Venous Thromboembolism Prophylaxis after Surgery
    1. Hip Replacement: 2.5 mg orally twice daily for 35 days
    2. Knee Replacement: 2.5 mg orally twice daily for 12 days

IX. Dosing: Renal Dosing Indications (2.5 mg orally twice daily)

  1. Serum Creatinine >1.5 mg/dl or higher OR
  2. Age >80 years old OR
  3. Weight <60 kg (or <132 lb)

X. Drug interactions

  1. Strong cytochrome P450 3A4 inducers
    1. Rifampin (also induces P-Glycoprotein)
    2. Phenytoin
    3. Carbamazepine
    4. Phenobarbital
  2. P-Glycoprotein Inhibitors
    1. Ketoconazole
    2. Itraconazole
    3. Voriconazole
    4. Ritonavir
    5. Conivaptan
  3. Other Anticoagulants and antiplatelet agents
    1. Aspirin and other antiplatelet agents (e.g. Clopidogrel)
    2. NSAIDs

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Cost: Medications

eliquis (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ELIQUIS 2.5 MG TABLET $6.21 each
ELIQUIS 5 MG TABLET $6.21 each

Ontology: apixaban (C1831808)

Definition (NCI) An orally active inhibitor of coagulation factor Xa with anticoagulant activity. Apixaban directly inhibits factor Xa, thereby interfering with the conversion of prothrombin to thrombin and preventing formation of cross-linked fibrin clots.
Definition (PDQ) An orally active inhibitor of coagulation factor Xa with anticoagulant activity. Apixaban directly inhibits factor Xa, thereby interfering with the conversion of prothrombin to thrombin and preventing formation of cross-linked fibrin clots. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=484444&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=484444&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C61308" NCI Thesaurus)
Concepts Pharmacologic Substance (T121)
MSH C522181
SnomedCT 698090000
LNC LP157546-5, MTHU045309
English 1H-Pyrazolo(3,4-c)pyridine-3-carboxamide, 4,5,6,7-tetrahydro-1-(4-methoxyphenyl)-7-oxo-6-(4-(2-oxo-1-piperidinyl)phenyl)-, apixaban, APIXABAN, Apixaban, Apixaban (substance), apixaban (medication), anticoagulants apixaban
Spanish apixabán, apixabán (sustancia)

Ontology: Eliquis (C3530466)

Concepts Pharmacologic Substance (T121)
English Eliquis