New Oral Anticoagulants – Eliquis® (apixaban)
What You Need to Know About Eliquis® (apixaban)
Last month we reviewed Xarelto® (rivaroxaban) recommendations for use including indications, dosing guidelines, and administration pearls. This month we will discuss Eliquis® (apixaban) which is a Factor Xa inhibitor similar to Xarelto® but is administered twice daily. Eliquis® and the other novel anticoagulants have several advantages over warfarin (Coumadin) including decreased risk for drug interactions, no PT/INR monitoring, and no dietary concerns. They do however have similar risks for bleeding. Given this potential for serious adverse events, it is vitally important that the entire interdisciplinary team is up to date on current guidelines for use.
Eliquis® (apixaban) Approved Indications and Dosages:
Non-vavular A.Fib. – Stroke and embolism prevention: 5mg PO twice daily.
DVT or PE Treatment: 10 mg PO twice daily for 7 days, then 5mg PO twice daily for at least 6 months.
DVT prevention post hip/knee surgery: 2.5 mg PO twice daily 12 days after knee replacement surgery or for 35 days after hip replacement surgery.
Administration:
May be taken without regard to food. For patients unable to swallow whole tablets, may crush and suspend the tablet in 60 ml 5% dextrose solution; administer immediately through a nasogastric tube. No information is available regarding oral administration of crushed and suspended tablets.
Dose adjustment for elderly:
Dosage adjustments are only required for residents with A.Fib. For residents with any 2 of the following characteristics: age >= 80 years; body weight <= 60 kg; or serum creatinine >= 1.5 mg/dL, reduce the dose to 2.5 mg PO twice daily.
Challenge yourself to know the names and dosages of these new oral anticoagulants. Ensure an accurate indication (diagnosis) is entered into your electronic health record. Utilize drug information resources to double check that the dose and duration are appropriate. Ask your AlixaRx Clinical Pharmacist for additional guidance on the use of these agents, we love drug information questions!
Don’t miss a review of Pradaxa® (dabigatran) in the next addition of From the Front Lines.
References: Clinical Pharmacology accessed 6/13/16. Available at: http://www.clinicalpharmacology.com/
This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.
