Apixaban

A single oral treatment that can be used from the start, taken with or without food.1 It doesn’t require initial treatment with LMWH, and so can be prescribed from the start in your patients with VTE.1

View the following video for an overview of how to prescribe apixaban in your patients with VTE, for both treatment and secondary prevention of VTE.

Apixaban is indicated for the treatment of DVT and PE, and prevention of recurrent DVT and PE in adults.

In summary, as shown, the dosing regimen requires initial treatment (apixaban 10mg BD) for the first 7 days, with simple sequential dose reduction between treatment phases*

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Apixaban should be used with caution in patients with severe renal impairment (CrCl 15–29 ml/min) for the treatment of DVT / PE and prevention of recurrent DVT / PE.1 Apixaban is not recommended in patients with CrCl <15 ml/min, or in patients undergoing dialysis.1
Not all patients who start on apixaban for acute DVT / PE will stay on apixaban; some acute DVT / PE patients who receive treatment do not require treatment for the prevention of recurrent DVT / PE. Other patients may be prescribed apixaban for the prevention of recurrent VTE after initial treatment for acute DVT / PE with another anticoagulant. This is a decision for the prescribing clinican together with patient involvement in the decision-making.
* As per medical guidelines, a short duration of treatment (at least 3 months) should be based on transient risk factors (e.g., recent surgery, trauma, or immobilisation).1 The duration of overall therapy should be individualised after careful assessment of the treatment benefit against the risk for bleeding.1

Twice-daily dosing

Apixaban is taken twice daily throughout treatment stages, providing your patients with VTE with a consistent dosing frequency whether they’re starting on apixaban, or require extended therapy for prevention of recurrence.1 With a half-life of 12 hours, apixaban twice-daily dosing gives your patients stable coverage throughout the day.1–4

Mean plasma concentration following multiple apixaban doses in healthy subjects2

PK / PD study design: the double-blind, randomised, placebo-controlled, parallel group, multiple-dose escalation study. Healthy subjects were randomised to apixaban or placebo for 7 days. Blood samples were taken to measure apixaban plasma concentration and for coagulation tests.2

* 10 mg OD is not licensed dose of apixaban for treatment of DVT / PE, or for prevention of recurrent DVT / PE, and is used only for illustrative purposes as the comparative dose in this dose-finding PK study.1,2 Please refer to the Apixaban SmPC for information regarding licensed doses.

To support you with prescribing apixaban in your patients with VTE you can use our DVT / PE Prescriber Checklist, available here.

Abbreviations

  • BD = Twice Daily
  • DVT = Deep Vein Thrombosis
  • LMWH = Low Molecular Weight Heparin
  • OD = Once Daily
  • PE = Pulmonary Embolism
  • PD = Pharmacodynamics
  • PK = Pharmacokinetics
  • VTE = Venous Thromboembolic Events

  1. Apixaban Summary of Product Characteristics.
  2. Frost C, Nepal S, Wang J, et al. Safety, pharmacokinetics and pharmacodynamics of multiple oral doses of apixaban, a factor Xa inhibitor, in healthy subjects. Br J Clin Pharmacol 2013;76:776–86. https://doi.org/10.1111/bcp.12106; PMID: 23451769.
  3. Lassen MR, Davidson BL, Gallus A, et al. The efficacy and safety of apixaban, an oral, direct factor Xa inhibitor, as thromboprophylaxis in patients following total knee replacement. J Thromb Haemost 2007;5:2368–75. https://doi.org/10.1111/j.1538-7836.2007.02764.x; PMID: 17868430.
  4. Leil TA, Feng Y, Zhang L, et al. Quantification of apixaban’s therapeutic utility in prevention of venous thromboembolism: selection of phase III trial dose. Clin Pharmacol Ther 2010;88:375–82. https://doi.org/10.1038/clpt.2010.106; PMID: 20686477.

December 2019
PP-ELI-GBR-6096