Apixaban

Question 1

What is the usual dose of apixaban?

Answer 1

5mg BD

Question 2

When would you reduce the dose of apixaban to 2.5mg BD?

Answer 2

At least 2 of the following:

• Age 80 years or over.
• Body weight 60 kg or less.
• Serum creatinine 1.5 mg/dL (133 micromol/L) or more.

Question 3

In which scenarios would you not prescribe apixaban?

Answer 3

• A creatinine clearance (CrCl) of less than 15 mL/min
• Active bleeding
• significant risk of major bleeding
• liver disease
• prosthetic heart valve

Question 4

How would you switch from warfarin to apixaban?

Answer 4

• If INR less than 2 = start apixaban
• If INR between 2 and 2.5 - start apixaban treatment the following day
• If INR greater than 2.5 - wait until its dropped to 2 before starting apixaban

Question 5

How would you switch from apixaban to warfarin?

Answer 5

• Start treatment with warfarin whilst taking the apixaban

- Prescribe both together until INR is in target range

Question 6

What tests are required prior to starting apixaban treatment?

Answer 6

Body weight1,2
Renal function (U&Es, calculated CrCl)1-5 see additional notes section
Baseline clotting screen3,4
Full blood count3,4
LFTs1-4
BP6

Question 7

What on going monitoring is required for apixaban?

Answer 7

U&Es, CrCl, LFTs, FBC