Anticoagulants · Hematology
Apixaban
Eliquis®(brand names vary by market)
The direct factor Xa inhibitor that made anticoagulation boring. In a good way.
Mechanism
Direct, reversible inhibitor of factor Xa: predictable effect at fixed doses, no INR, effect on within hours.
Open the interactive pathwayIndications
- Stroke prevention in atrial fibrillation
- Treatment and prevention of venous thromboembolism
Formulations
Dosing concepts
AF dose reduction
The reduced dose applies only when at least two of: age ≥80, weight ≤60 kg, creatinine ≥133 µmol/L. Under-dosing without criteria is a common real-world error.
Not for
Mechanical valves and antiphospholipid syndrome stay with warfarin.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~50%
- Half-life
- ~12 h
- Elimination
- mixed: ~27% renal; CYP3A4 and P-gp substrate
Adverse effects
- Bleedingcommon & seriousLess intracranial bleeding than warfarin in AF trials.
Contraindications & precautions
Contraindications
- Active major bleeding
- Mechanical heart valves
- Severe hepatic disease with coagulopathy
Precautions
- Strong dual CYP3A4 + P-gp inhibitors or inducers
- Advanced renal impairment
Interactions
Monitoring
Renal function
Dose criteria and accumulation risk · Baseline and at least annually, sooner when unwell
Adherence
Short half-life means missed doses are unprotected days
Bleeding signs
The trade being made
Counselling points
- Twice daily, roughly twelve hours apart; protection fades quickly if doses are missed.
- No routine blood test measures this drug. Taking it is the test.
- Same bleeding warnings as any anticoagulant; and always mention it before procedures.
Clinical pearls
- The DOAC paradox: freedom from INR checks makes adherence invisible. Ask about it on purpose.
References & review
- Apixaban product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-15 · jurisdiction: global · drug information changes; verify against current references before practice use.