Apixaban is an OAC with a 12- to 24-hour postsurgical initiation window2
The ﬁrst dose of Apixaban 2.5 mg twice-daily should be taken 12 to 24 hours after surgery2
Apixaban provides reduction in total VTE/all-cause death vs. enoxaparin following total hip or knee replacement, with comparable rates of bleeding2,3,4
Twice-daily oral Apixaban 2.5 mg demonstrated2,3,4
Use of Apixaban with Epidural Catheters2
There is no clinical experience with the use of Apixaban with indwelling intrathecal or epidural catheters. Should the need occur:2
- Based on pharmacokinetic data, a time interval of 20-30 hours (i.e. 2x half-life) between the last dose of Apixaban and catheter withdrawal should elapse
- At least one dose of Apixaban should be omitted before catheter withdrawal
- The next dose of Apixaban may be given at least 5 hours after catheter removal
Indwelling epidural or intrathecal catheters must be removed at least 5 hours prior to the first dose of ELIQUIS®2
BID: twice daily; DVT: deep-vein thrombosis; QD: once daily; SC: subcutaneous; THR: total hip replacement; VTE: venous thromboembolism.
References: 1 Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-992. 2. Based on Apixaban LPDELI052021 (Version no. 13), dated 17th June 2021. 3. Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Hornick P; ADVANCE-2 investigators. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomized double-blind trial. Lancet. 2010;375(9717):807-815. 4. Lassen MR, Gallus A, Raskob GE, Pineo G, Chen D, Ramirez LM; ADVANCE-3 Investigators. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med. 2010;363(26):2487-2498.
#Ruff CT, et al. Lancet. 2014;383(9921):955-62, Hur et al, Acta Orthopaedica 2017; 88 (6): 634–641, Cohen AT et al. Adv Ther 2014;31:473-93
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