Apixaban is a highly selective, reversible, direct oral anticoagulant (DOAC) that directly inhibits Factor Xa, a key enzyme in the coagulation cascade. It is a cornerstone of modern anticoagulation therapy in India, offering predictable pharmacokinetics, fewer drug and food interactions compared to warfarin, and no requirement for routine INR monitoring. It is widely used for stroke prevention in non-valvular atrial fibrillation (NVAF) and for the treatment and prevention of venous thromboembolism (VTE).
Adult: For Stroke Prevention in NVAF: 5 mg orally twice daily. For VTE Treatment: 10 mg twice daily for 7 days, followed by 5 mg twice daily. For VTE Prophylaxis post-surgery: 2.5 mg twice daily for 35 days (hip) or 12 days (knee).
Note: Can be taken with or without food. Tablet should be swallowed whole with a glass of water. Do not crush or chew. If a dose is missed, take it as soon as remembered on the same day, then resume twice-daily schedule. Do not double the dose to make up for a missed dose.
Apixaban is a selective, reversible, competitive inhibitor of free and clot-bound Factor Xa, and Factor Xa within the prothrombinase complex. By inhibiting Factor Xa, it prevents the conversion of prothrombin (Factor II) to thrombin (Factor IIa), thereby inhibiting thrombin-mediated platelet activation and fibrin clot formation.
Pregnancy: Category B: Animal studies show no risk, but no adequate, well-controlled studies in pregnant women. Use only if potential benefit justifies potential risk to the fetus. Risk of maternal and fetal hemorrhage. Should be avoided, especially during delivery.
Driving: Apixaban has no known influence on the ability to drive and use machines. However, dizziness or syncope due to anemia from bleeding may occur.
| Ketoconazole, Itraconazole, Voriconazole, Posaconazole | Increased apixaban exposure (AUC) by ~100%; increased bleeding risk | Contraindicated/High |
| Ritonavir, Atazanavir, Clarithromycin | Significantly increased apixaban levels; increased bleeding risk | Contraindicated/High |
| Rifampicin, Carbamazepine, Phenytoin, St. John's Wort | Significantly decreased apixaban levels; reduced efficacy | Contraindicated/High |
| Aspirin, Clopidogrel, Ticagrelor | Increased risk of bleeding | Moderate/High (requires careful assessment) |
| NSAIDs (e.g., Diclofenac, Ibuprofen) | Increased risk of gastrointestinal bleeding | Moderate |
| Selective Serotonin Reuptake Inhibitors (SSRIs) | May increase bleeding risk due to antiplatelet effect | Low/Moderate |
| Heparins, Warfarin | Increased bleeding risk | Contraindicated/High |