Antiplatelet Agents
Severe
Textbook
Increased risk of bleeding.
Exercise caution and monitor closely.
Source: G&G 14e
Drug reference
Apixaban
Direct factor Xa inhibitor (DOAC) · Anticoagulant
Also known as Eliquis
START
AF 5 mg BID (2.5 mg BID if ≥2 of age≥80/≤60 kg/Cr≥1.5); VTE 10 mg BID ×7 days → 5 mg BID
TYPICAL MAX
10 mg BID (VTE initiation); 5 mg BID maintenance
STOP IF
Active major bleeding; hold appropriately around neuraxial anaesthesia/surgery; do not stop abruptly without bridging if still indicated
WATCH
Renal/hepatic function, Hb/bleeding, dose-reduction criteria, neuraxial timing; andexanet alfa for life-threatening bleed
CDSCO approvedSchedule HATC B01AF02
KDIGO 2024 + manufacturer label
- ONSET
- 2h · anticoagulant onset
- PEAK
- 3.5h · Cmax
- t½
- 12h · plasma t½
- DURATION
- 12h · BID interval
EXCRETION
Hepatic CYP3A4/P-gp; ~27% renal
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Avoid — potential reproductive/bleeding risk; use LMWH instead
FDA category + note
Top interactionssee all 12 →
- Antiplatelet AgentsSevereTextbookG&G 14e
- Nonsteroidal Anti Inflammatory AgentsSevereTextbookG&G 14e
- AbciximabSevereDatabaseDDInter
- AcalabrutinibSevereDatabaseDDInter
Available in India
23 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Selective reversible direct inhibition of free and clot-bound factor Xa, reducing thrombin generation and thrombus formation without antithrombin requirement.
Indications
Stroke prevention in non-valvular atrial fibrillationTreatment of DVT/PE and secondary preventionVTE prophylaxis after hip/knee arthroplasty
Dosing
- Adult
- AF: 5 mg BID (2.5 mg BID if ≥2 of: age ≥80, weight ≤60 kg, creatinine ≥1.5 mg/dL). VTE treatment: 10 mg BID ×7 days then 5 mg BID; long-term prophylaxis 2.5 mg BID. Hip/knee VTE prophylaxis 2.5 mg BID.
- Pediatric
- Weight-based (paediatric VTE — per label).
- Renal adjustment
- AF: apply the 2.5 mg BID criteria (incl. serum creatinine ≥1.5). ESRD/dialysis: limited data — 5 mg BID per US label (specialist).
- Hepatic adjustment
- Mild (Child-Pugh A): no adjustment. Moderate (B): use with caution. Severe (C): not recommended.
- Geriatric
- Apply dose-reduction criteria; bleeding vigilance.
- Max dose
- 10 mg BID (VTE initiation phase); 5 mg BID maintenance
Pharmacokinetics
Onset
~1–3 h (anticoagulant)
Peak effect
Cmax ~3–4 h
Duration
~12 h (BID)
Half-life
~12 h
Bioavailability
~50%
Protein binding
~87%
Metabolism
Hepatic CYP3A4 (major) + others; P-gp substrate
Excretion
~27% renal; remainder faecal/biliary/metabolic
Contraindications
- Active clinically significant bleeding
- Lesion/condition at high bleeding risk
- Hepatic disease with coagulopathy
- Mechanical prosthetic heart valve / moderate–severe mitral stenosis
- Hypersensitivity to apixaban
Side effects
Common
Bleeding (bruising, epistaxis, GI, GU)AnaemiaNauseaHaematoma
Serious
- Major/fatal haemorrhage (GI, intracranial)
- Spinal/epidural haematoma with neuraxial procedures (boxed)
- Increased thrombotic risk if discontinued prematurely (boxed)
- Severe hypersensitivity
Pregnancy & lactation
Pregnancy
Avoid — potential reproductive/bleeding risk; use LMWH instead
Lactation
Avoid — excreted in animal milk; use alternative
Drug interactions
Nonsteroidal Anti Inflammatory Agents
Severe
Textbook
Increased risk of bleeding.
Exercise caution and monitor closely.
Source: G&G 14e
Abciximab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Acalabrutinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Alteplase
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anagrelide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anisindione
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anistreplase
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Antithrombin Alfa
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Antithrombin Iii Human
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Apalutamide
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Ardeparin
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Ask House about Apixaban
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Harrison 22e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19