Noval anticoagulants - apixaban

Question 1

What is the brand name of apixaban?

Answer 1

• Apixaban (Eliquis)

Question 2

What is the method of action of apixaban?

Answer 2

• Direct inhibitor of free and clot bound factor Xa

Question 3

What are the indications for apixaban?

Answer 3

• Prophylaxis of VTE in elective hip/knee replacement
• Prophylaxis of stroke
• Prophylaxis of systemic emboli in non valvular AF and one other risk factor (TIA, previous stroke, symptomatic heart failure, diabetes, hypertension, age >75)
• Treatment of DVT
• Treatment of PE

Question 4

What are the contraindications for apixaban?

Answer 4

• Active significant bleeding
• Surgery – discontinued 24-48h before
• Hepatic disease associated with coagulopathy and clinically relevant bleeding risk
• Condition considered a significant risk factor for major bleeding e.g. GI ulceration, intracranial haemorrhage
• Renal impairment – reduce dose if creatinine clearance low

Question 5

What are the side effects of apixaban?

Answer 5

• Haemorrhage – nose, gums, urine etc.
• Bruising
• Nausea
• Anaemia
• Hypotension
• Thrombocytopenia
• Rash

Question 6

What are the interactions with apixaban?

Answer 6

• Anticoagulants/anti-platelets - ↑ bleeding risk
• NSAIDs - ↑ bleeding risk
• Azoles – strong inhibitor of CYP3A4 so ↑ concentration
• High blood pressure/heart problem medication e.g. diltiazem - ↑ bleeding risk
• HIV protease inhibitors – strong inhibitor of CYP3A4 so ↓ concentration
• Epilepsy medication e.g. phenytoin - ↑ clot risk
• St John’s Wort - ↑ clot risk

Question 7

Which organs eliminate apixiban?

Answer 7

• Renal (27%), biliary and intestinal

Question 8

What patient information should be given to patients on apixaban?

Answer 8

• Try to take the medication at the same time everyday