Stephan Moll, MD writes…
Apixaban (Eliquis®) is FDA-approved for the prevention of stroke and systemic arterial thromboembolism in patients with atrial fibrillation (Clot Connect discussion of the approval on Dec 28th, 2012 is here). Here is the management guideline for apixaban established at our institution, the University of North Carolina (UNC) Health Care System. A number of practical management questions encountered by physicians, pharmacists, and other health care professional taking care of patients on apixaban are addressed:
- dosing in renal impairment
- conversion of a patient on warfarin to apixaban,
- discontinuation of apixaban at times of surgery, dental procedures, colonoscopy, and other procedures,
- management of bleeding on apixaban.
The reader is welcome to take the document and modify it to fit his/her institution/ practice’s need or use it as a clinical reference.
In respect to venous thromboembolism, the disease entity that Clot Connect mostly focuses on:
- Apixaban is not FDA approved at this point for VTE prevention or treatment.
- The phase 3 clinical trial of apixaban in patients with acute VTE is still ongoing (link here) and results are expected in the 2nd part of 2013.
- The apixaban secondary prevention trial (AMPLIFY-EXTENSION) was published in the N Engl J Med on Dec 8th, 2012, showing that apixaban, compared to placebo, decreased the risk of recurrent VTE without increasing the rate of major bleeding [ref 1].
- Agnelli G et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. Dec 8, 2012, pre-published on the web.
Disclosure: I have consulted for Janssen, Boehringer-Ingelheim, and Daiichi.
Last updated: Feb 5th, 2013