Apixaban (Eliquis) is an oral direct inhibitor of factor Xa. There are no specific antidotes against apixaban. A possible antidote Andexanet alfa for Factor Xa-inhibitors is currently under investigation.
Elimination half-life is 9–14 hours.
Surgery should be delayed for 48 hours after administration of the last dose. Bridging anticoagulation is not recommended. Neuraxial blockade is possible 26–30 hours after the last dose.
Consider giving FFPs or rFVIIIa (NovoSeven) in case of acute bleeding. Resume apixaban 24–48 hours postoperatively or switch to standard thromboprophylaxis with LMWH 12–24 hours postoperatively depending on the individual postoperative bleeding risk or risk for thromboembolic complications.
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