Apixaban
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Apixaban. Apixaban is a factor Xa inhibitor. It is superior to warfarin. Fully referenced neurology checklist.
Pharmacology
- Apixaban is a factor Xa inhibitor
- It is superior to warfarin
- It is excreted via the liver: via the CYP3A4 enzyme pathway
- It has less bleeding and lower mortality than Warfarin
- The bleeding risk is not higher than that of Aspirin
Indications
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Dose in stroke prophylaxis
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Dose monitoring
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Indications for using 2.5mg twice daily: ≥2 of
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Precautions
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Management of bleeding: Andexanet alfa
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Management of bleeding: other measures
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References
- Mezue K, Obiagwu C, John J, Sharma A, Yang F, Shani J. Novel Oral Anticoagulants in Atrial Fibrillation: Update on Apixaban. Curr Cardiol Rev; 13:41-46.
- Tendera M, Syzdol M, Parma Z. ARISTOTLE RE-LYs on the ROCKET. What's new in stroke prevention in patients with atrial fibrillation? Cardiol J 2012; 19:4-10.
- Flaker GC, Eikelboom JW, Shestakovska O, et al. Bleeding during treatment with aspirin versus apixaban in patients with atrial fibrillation unsuitable for warfarin: the apixaban versus acetylsalicylic acid to prevent stroke in atrial fibrillation patients who have failed or are unsuitable for vitamin K antagonist treatment (AVERROES) trial. Stroke 2012; 43:3291-3297.
- Granger CB, Alexander JH, McMurray JJ, et al; ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365:981-992.
- Kamel H, Longstreth WT Jr, Tirschwell DL, et al. Apixaban versus aspirin and risk of hemorrhage in the ARCADIA trial. Ann Neurol 2026 (Online ahead of print).
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