Description
Dosage Forms & Strengths tablet
2.5mg
5mg
Stroke Prophylaxis with Atrial Fibrillation
To prevent stroke and systemic embolism in nonvalvular atrial fibrillation
5 mg PO BID
Renal impairment (nonvalvular atrial fibrillation)
Mild-to-moderate: No dosage adjustment required
Serum creatinine ≥1.5 mg/dL: Decrease dose to 2.5 mg BID if patient has 1 additional characteristic of age ≥80 years or weight ≤60 kg
ESRD maintained on hemodialysis: 5 mg BID; decrease dose to 2.5 mg BID if 1 additional characteristic of age ≥80 years or weight ≤60 kg is present
Postoperative Prophylaxis of DVT/PE
Indicated following hip or knee replacement surgery
Initial: Give 2.5 mg PO 12-24 hr after surgery
Duration of therapy (hip replacement): 2.5 mg PO BID for 35 days
Duration of therapy (knee replacement): 2.5 mg PO BID for 12 days
Renal impairment, including with ESRD on dialysis
Deep Vein Thrombosis: No dose adjustment recommended; not studied in ESRD on dialysis or patients with a CrCl <15 mL/min; dosing recommendations based on pharmacokinetic and pharmacodynamic (anti-FXa activity) data in study subjects with ESRD maintained on dialysis
DVT or PE Treatment
Indicated for treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE)
10 mg PO BID x 7 days, then 5 mg BID
Reduce risk for recurrent DVT or PE
Indicated to reduce the risk of recurrent DVT and PE following initial 6 months treatment for DVT and/or PE
2.5 mg PO BID
Renal impairment, including with ESRD
Deep Vein Thrombosis: No dose adjustment recommended; not studied in ESRD on dialysis or patients with a CrCl <15 mL/min; dosing recommendations based on pharmacokinetic and pharmacodynamic (anti-FXa activity) data in study subjects with ESRD maintained on dialysis
Dosage Modifications
Coad ministration with dual inhibitors of CYP3A4 and P-gp
If taking >2.5 PO BID, decrease dose by 50%
If taking 2.5 mg BID, avoid Coad ministration with strong dual inhibitors
Nonvalvular atrial fibrillation
Decrease dose to 2.5 mg PO BID in patients with any 2 of the following characteristics:
Age ≥80 years
Weight ≤60 kg
Serum creatinine ≥1.5 mg/dL
Hepatic impairment
Mild: No dosage adjustment required
Moderate: Patients may have intrinsic coagulation abnormalities; data are limited and no recommendations are available
Severe: Not recommended
Dosing Considerations
Switching between apixaban and anticoagulants other than warfarin: Discontinue one being taken, and begin the other at the next scheduled dose
Switching from warfarin to apixaban: Discontinue warfarin and initiate apixaban when INR <2.0
Switching from apixaban to warfarin
Apixaban affects INR, so measurements during Coad ministration with warfarin may not determine appropriate warfarin dose
If continuous anticoagulation is necessary, discontinue apixaban and begin both a parenteral anticoagulant and warfarin at the time the next dose of apixaban would have been taken
Discontinue parenteral anticoagulant when INR reaches an acceptable level
Surgery/procedures
Discontinue at least 48 hr. before elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding
Discontinue at least 24 hr. before elective surgery or invasive procedures with low risk of unacceptable bleeding or where bleeding would be noncritical in location and easily controlled
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