Apixaban
Brand names: Eliquis
Class: 🩸 Anticoagulants & Antiplatelets
The AANP exam tests apixaban as the DOAC of choice in patients with reduced kidney function or higher bleed risk. It directly inhibits Factor Xa, prevents stroke in non-valvular atrial fibrillation, and treats and prevents venous thromboembolism without routine INR monitoring. Dosing is 5 mg twice daily; drop to 2.5 mg twice daily if any two of: age ≥80, weight ≤60 kg, or creatinine ≥1.5. The reversal agent is andexanet alfa. Apixaban is contraindicated in mechanical heart valves and in moderate-to-severe mitral stenosis — both still require warfarin. Drug interactions matter: avoid combining with strong dual CYP3A4 and P-gp inhibitors or inducers.
✅ Indications
A-fib stroke prevention, VTE treatment + prevention, post-surgical VTE prophylaxis.
⚙️ Mechanism of Action
Direct factor Xa inhibitor.
📏 Dosing
5 mg PO BID (2.5 mg if 2 of 3: age ≥80, weight ≤60 kg, Cr ≥1.5).
🚫 Contraindications
Active bleeding, mechanical heart valves, moderate-severe mitral stenosis (rheumatic), pregnancy (limited data).
⚠️ Adverse Effects
Bleeding (less ICH than warfarin), anemia, GI bleed (less than rivaroxaban/dabigatran).
🔬 Monitoring
Annual CBC, renal function, LFTs. No routine anti-Xa levels.
💎 Board Pearls
- 🏆 BEST-TOLERATED DOAC — least renal clearance (25%), least GI bleed, BID dosing.
- 💊 Dose reduction trigger: 2 of 3 (age ≥80, wt ≤60 kg, Cr ≥1.5).
- 🆘 Reversal: andexanet alfa (factor Xa inhibitor antidote).
- 🫀 CKD: apixaban preferred DOAC when eGFR 15–29.
Practice Questions
You are reviewing the chart of an 82-year-old woman with nonvalvular atrial fibrillation being started on apixaban (Eliquis). She weighs 55 kg and her most recent serum creatinine is 1.6 mg/dL. Which apixaban dose is most appropriate?
Related Drugs in This Class
- Warfarin — Coumadin, Jantoven
- Rivaroxaban — Xarelto
- Aspirin — Bayer, Ecotrin
- Clopidogrel — Plavix
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