Apixaban management guideline posted to ClotConnect

In early January, the oral factor Xa inhibitor apixaban (Eliquis^®) became the third novel anticoagulant approved by the FDA for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation.  Several colleagues and I developed a guideline for its practical management, which has now been posted to ClotConnect, an educational website for patients and health care providers developed by Hemophilia and Thrombosis Center at the University of North Carolina at Chapel Hill.  The guideline provides recommendations on the following:

• Considerations for initiation of therapy (dosing and administration, monitoring parameters, cost considerations)
• Conversions to and from other anticoagulants, including unfractionated heparin, low molecular weight heparin, fondaparinux, dabigatran, rivaroxaban, and warfarin
• Perioperative management
• Management of hemorrhagic events
• Patient education

As was the case with guidelines for the other new oral anticoagulants (dabigatran here and rivaroxaban here), many of the recommendations included in this document have been extrapolated from pharmacokinetic and other pre-clinical investigations, as there is still little other evidence to help guide clinicians in the practical management of these new agents.  One can reasonably expect this information to evolve significantly as we gain more practical experience with it and the other new oral anticoagulants.  However, in the meantime, we hope this resource will be useful in assisting other institutions and individual providers who are already using apixaban in clinical practice. 

Special thanks goes to Ilya Danelich, PharmD, BCPS, who was our cardiology pharmacy resident last year; and Stephan Moll, MD, for their assistance in the development of this document.