Direct factor Xa inhibitorADHERENCE CRITICAL
Apixaban
Eliquis
Direct-acting factor Xa inhibitor with fixed dosing and no routine monitoring. Lower risk of intracranial haemorrhage than warfarin — but the short half-life means a missed dose has consequences within hours.
BOXED WARNING
Premature discontinuation without bridging increases the risk of thrombosis. Spinal or epidural puncture during treatment may cause spinal haematoma.
Dosing in adults
By indicationuppdaterad 2026-08-19
| Indication | Regimen | Comment |
|---|---|---|
| Atrial fibrillation | 5 mg × 2 orally | no monitoring required |
| Atrial fibrillation, dose reduction | 2,5 mg × 2 orally | if 2 of 3: age ≥ 80, weight ≤ 60 kg, creatinine ≥ 133 µmol/l |
| Venous thromboembolism | 10 mg × 2 for 7 days → 5 mg × 2 | no initial LMWH required |
| Extended secondary prophylaxis | 2,5 mg × 2 after 6 months | in persistent risk |
Renal impairment
Avoid at eGFR < 15. Dose reduction according to the criteria above, not on eGFR alone.
Hepatic impairment
Avoid in Child–Pugh C and in coagulopathy.
Children
Not indicated.
Pitfall
Do not switch to apixaban in mechanical heart valve prosthesis or moderate-to-severe mitral stenosis — warfarin remains the only option in those cases.
Pharmacokinetics
- BIOAVAIL.
- 50 %
- Vd
- 21 l
- t½
- 12 h
- PROTEIN BINDING
- 87 %
- METABOLISM
- CYP3A4 (partial)
- EXCRETION
- 27 % renal
- SUBSTRATE
- P-glycoprotein, BCRP
- ONSET
- 3–4 h
Adverse effects by frequency
≥ 10 %
Bruising, epistaxis
1–10 %
Gastrointestinal bleeding, anaemia, haematuria
< 1 %
Intracranial haemorrhage, spinal haematoma