Apixaban is an oral and selective factor Xa inhibitor anticoagulant approved for the prevention of stroke and systemic embolism in patients with nonvalvular AF. Apixaban carries a black box warning against abrupt discontinuation in patients with AF. Apixaban was FDA-approved in December 2012.
Important administration considerations:
- For nonvalvular AF
When transitioning from warfarin to apixaban, discontinue warfarin and start apixaban as soon as INR <2.0
When converting from apixaban to warfarin, discontinue apixaban and begin warfarin + a parental anticoagulant at the time the next dose of apixaban would have been administered. Discontinue the parenteral anticoagulant when INR is therapeutic.
To convert between apixaban and anticoagulants other than warfarin: Discontinue current agent and initiate the preferred agent at the time that the next dose would have been administered.
Avoid concomitant administration with rifampin, carbemazepine, phenytoin and St. Johns Wort
More expensive than warfarin
No reversal agent
No INR monitoring required
Rapid onset of effect
- For most patients, the standard dose is 5mg twice daily
- Can be taken without regard to food
- Reduce to 2.5mg twice daily if any two of the following: age >= 80 years; body weight <= 60 kg; or serum creatinine >= 1.5 mg/dl.
- Also reduce to 2.5mg twice daily if the patient is taking a drug that is a strong inhibitor of both CYP3A4 and P-glycoprotein (ketoconazole, itraconazole, ritonavir, clarithromycin).
Relevant clinical trials*:
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