Apixaban for VTE

1. Apixaban

2. Pharmacology
 Direct Xa inhibitor
 Absorption 3-4 hrs
 Half Life 12 Hrs BD dosing
 Metabolism –Hepatic predominantly;CYP3A4

3. Dosing
Treatment of DVT/PE
 10 mg BD x 1 week5 mg BD
Prophylaxis
 2.5 mg BD

4. Dose Adjustment
Renal Dose Modification
 No Clear safety data on use in Sr Creatinine>2.5 mg/dl or Cr Cl< 25ml/min
 Otherwise no dose adjustment
Hepatic Dose modification
 Child-Pugh-A no dose modification
 Child-Pugh-B use with caution
 Child-Pugh-C Not recommended
Geriatric
 If > 80yrs & Weight <60 kg or Sr Creat >1.5 mg/dl
 Dose 2.5 mg BD

5. Transition
 Transition from LMWH –give Apixaban when Next dose of LMWH(Is
scheduled
Or
 In Acute DVT Within 6-12 hrs after the last dose of LMWH

6.  RCT
 1:1
 Apixaban vs Dalteparin
 1170 pts

7. Exclusions
 Basal-cell or squamous-cell carcinoma of the skin
 Primary brain tumor, known intracerebral metastases,
 Acute leukemia

10. Cost
Dabigatran Apixaban
Treatment 150mg BD
Rs 60/day
5 mg BD
Rs 60/day
Prophylaxis 110 mg BD
Rs 50/day
2.5 mg BD
Rs 50/day

11. Advantages
 No need of Bridging,
 Hospitalisation not required for Patients
 Similar Efficay/Similar adverse events