Monitor for signs/symptoms of blood loss. Most Monitor Closely (1)itraconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)cenobamate will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ibuprofen and apixaban both increase anticoagulation. Use Caution/Monitor. Dronedarone also inhibits P-gp activity, which can further increase rivaroxaban serum levels; since both pathways of rivaroxaban elimination are affected, patients with renal impairment receiving rivaroxaban with drugs that are combined P-gp and moderate CYP3A4 inhibitors may have significant increases in exposure compared to patients with normal renal function; since the drug combination may increase bleeding risk, monitor closely. Avoid or Use Alternate Drug. Effect of apixaban on coagulation assays26,27. Anti-Xa assay useful in determining if anticoagulant effect present, Nonvalvular atrial fibrillation: 5 mg twice daily, THR prophylaxis: 2.5 mg twice daily for 35 days, TKR prophylaxis: 2.5 mg twice daily for 12 days, VTE treatment: 10 mg twice daily for 7 days, then 5 mg twice daily, Prophylaxis of recurrent VTE: 2.5 mg twice daily after at least 6 months of treatment. If you fall or injure yourself, especially if you hit your head, contact your doctor right away. Monitor Closely (1)escitalopram increases effects of apixaban by anticoagulation. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Use Caution/Monitor. Serious - Use Alternative (1)enoxaparin and apixaban both increase anticoagulation. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid. Serious - Use Alternative (1)argatroban and apixaban both increase anticoagulation. fluvoxamine increases effects of apixaban by anticoagulation. Avoid or substitute another drug for these medications when possible. Use Caution/Monitor. ketorolac and apixaban both increase anticoagulation. The need for simultaneous use of low-dose aspirin (<100 mg/day) with anticoagulants are common for patients with cardiovascular disease, but may result in increased bleeding; monitor closely. Prothrombin complex concentrates (PCCs) are typically utilized in the event of life threatening hemorrhage, however recombinant activated factor VII is an acceptable alternative.42 Perlstein et al studied the effects of four-factor PCCs on apixaban pharmacodynamics in 15 healthy subjects following the administration of apixaban 10 mg orally twice daily.43 The four-factor PCC reversed the steady-state pharmacodynamic effects of apixaban in several coagulation assessments suggesting that four-factor PCCs may be useful in the management of bleeding in patients on apixaban. flurbiprofen and apixaban both decrease anticoagulation. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. venlafaxine and apixaban both increase anticoagulation. Use Caution/Monitor. The principal safety outcomes were major bleeding alone as defined by International Society on Thrombosis and Haemostasis and major bleeding plus CRNM bleeding.21 In the apixaban group, adherence to therapy was at least 80% in 96% of the patients, while the INR was therapeutic (2.03.0) 61% of the time in the conventional therapy group. Contraindicated. edoxaban, apixaban. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. quinidine will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Some conditions may become worse when this drug is suddenly stopped. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents; patients requiring anticoagulation while on imatinib should receive LMWH or unfractionated heparin instead of warfarin because of multiple interaction mechanisms of imatinib with warfarin. Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Portman RJ. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp. Lopez-Jimenez L, Montero M, Gonzalez-Fajardo JA, et al. The predictable pharmacokinetics, limited medication interactions, lack of required laboratory monitoring, and potentially improved cost-effectiveness48 render apixaban an attractive alternative to other anticoagulants such as warfarin. Avoid or Use Alternate Drug. Use Caution/Monitor. Avoid or Use Alternate Drug. Contraindicated. Serious - Use Alternative (1)piroxicam and apixaban both increase anticoagulation. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Use Caution/Monitor. Use Caution/Monitor. Serious - Use Alternative (1)indomethacin and apixaban both increase anticoagulation. This information does not assure that this product is safe, effective, or appropriate for you. Monitor Closely (1)fluvoxamine increases effects of apixaban by anticoagulation. Laulicht B, Bakhru S, Lee C, et al. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. Contraindicated. Contraindicated (1)defibrotide increases effects of apixaban by pharmacodynamic synergism. The need for simultaneous use of low-dose aspirin (<100 mg/day) with anticoagulants are common for patients with cardiovascular disease, but may result in increased bleeding; monitor closely. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. The authors concluded that extended antico-agulation with apixaban at either treatment dose (5 mg) or thromboprophylaxis dose (2.5 mg) reduced the risk of recurrent VTE without increasing the rate of major bleeding. A Canadian study of the cost-effectiveness of apixaban compared with enoxaparin for post-surgical venous thromboembolism prevention. PRECAUTIONS: Before taking apixaban, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. pharmacodynamic antagonism. dronedarone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)caplacizumab, apixaban. ANNEXA-A PART 2: A phase 3 randomized, double-blind, placebo-controlled trial demonstrating sustained reversal of apixaban-induced anticoagulation in older subjects by andexanet Alfa (PRT064445), a universal antidote for factor Xa (FXA) inhibitors. Contraindicated.Monitor Closely (1)mifepristone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Reduce apixaban dose by 50% when mifepristone used for treatment of Cushing's disease or other hormonal conditions; if patients are already receiving 2.5 mg twice daily, avoid coadministration. Avoid or Use Alternate Drug. Data from the ADVANCE-3 trial led to the FDA approval of apixaban for prevention of DVT following hip replacement surgery.23 In this study, 5,407 patients undergoing THR or revision of a previously inserted hip prosthesis were randomly assigned to receive apixaban 2.5 mg orally twice daily or enoxaparin 40 mg subcutaneously daily. Avoid or Use Alternate Drug. Managing target-specific oral anticoagulant associated bleeding including an update on pharmacological reversal agents. Nutescu EA. Reduces anticoagulant effect by decreasing apixaban systemic exposure. Avoid or Use Alternate Drug. Avoid or substitute another drug for these medications when possible. Use Caution/Monitor. Serious - Use Alternative (1)tenecteplase and apixaban both increase anticoagulation. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada). Finally, in low-risk patients such as bileaflet aortic valve replacement (AVR) without major risk factors for stroke, CHADS2 score of 02 and no prior stroke or transient ischemic attack, or VTE >12 months prior, the risk of ATE is <4% annually and VTE is <2% per month, thus these patients do not require bridging anticoagulation. Use Caution/Monitor. Use Caution/Monitor. This does not include use for routine maintenance or reopening of central venous lines. sharing sensitive information, make sure youre on a federal Avoid or Use Alternate Drug. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs. Avoid or Use Alternate Drug. Major or CRNM bleeding occurred in 4% of the apixaban group versus 5% of the enoxaparin arm (P=0.09). Small molecule antidote for anticoagulants [abstract]. Avoid or Use Alternate Drug. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. carbamazepine will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. MISSED DOSE: If you miss a dose, take it as soon as you remember. Avoid or Use Alternate Drug. Monitor Closely (1)verapamil will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Apixaban is FDA-approved for the primary prevention of DVT, which may lead to PE, following hip or knee replacement surgery based upon the following trials. Apixaban was initiated 1224 hours following wound closure and enoxaparin 12 hours prior to surgery. naproxen and apixaban both decrease anticoagulation. Avoid or Use Alternate Drug. 20022098556-overviewDiseases & Conditions, You are being redirected to Monitor Closely (2)stiripentol, apixaban. Avoid or Use Alternate Drug. Economic burden of venous thromboembolism in hospitalized patients. Avoid or Use Alternate Drug. Use Caution/Monitor. FXa chromogenic assays illustrated high sensitivity and a linear correlation depending upon the reagent and or the methodology utilized, thus serve as the assay of choice to measure for the presence of apixaban.27 Additional details regarding the effects of apixaban on coagulation assays are delineated in Table 3. Reduce P-gp substrate dose if needed.Serious - Use Alternative (1)lonafarnib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. The recipient will receive more details and instructions to access this offer. Apixaban is a both CYP3A4 and P-gp substrate. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Compare formulary status to other drugs in the same class. Properly discard this product when it is expired or no longer needed. Do not store in the bathroom. Serious - Use Alternative (1)flurbiprofen and apixaban both decrease anticoagulation. secobarbital will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)levoketoconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Promptly evaluate any signs or symptoms of blood loss if treated concomitantly with low-dose aspiriin. Use Caution/Monitor. Lonafarnib is a weak P-gp inhibitor. Serious - Use Alternative (1)dabigatran and apixaban both increase anticoagulation. iloperidone increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Do not run out of this medication. Serious - Use Alternative (1)ketoconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Serious - Use Alternative (1)meclofenamate and apixaban both increase anticoagulation. glecaprevir/pibrentasvir will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. CYP3A4 substrates may require dosage adjustment.stiripentol will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Venous thromboembolism (VTE) results in significant morbidity and mortality. imatinib, apixaban. Modify Therapy/Monitor Closely. Use Caution/Monitor. In patients with cancer, there is no published data regarding the efficacy and safety of the TSOACs in the management of acute VTE. Reduces anticoagulant effect by decreasing apixaban systemic exposure. rivaroxaban and apixaban both increase anticoagulation. Avoid or Use Alternate Drug. Granger C, Alexander J, McMurray J, et al. Avoid or Use Alternate Drug. Contraindicated (1)apixaban, prothrombin complex concentrate, human. Use Caution/Monitor. Avoid or Use Alternate Drug. Chromogenic protein C antigen or activity, free protein S antigen, and fibrinogen were also not influenced by apixaban. Serious - Use Alternative (1)venlafaxine and apixaban both increase anticoagulation. Short-term coadministration may be needed for patients transitioning to or from edoxaban. Long-term concomitant treatment with edoxaban and other anticoagulants is not recommended. Monitor Closely (1)melatonin increases effects of apixaban by anticoagulation. Contraindicated (1)St John's Wort will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. In a meta-analysis performed by Pathak et al bleeding risk with apixaban was noted to be lower when compared to conventional anticoagulants (enoxaparin and warfarin) and antithrombotics such as aspirin, in patients with mild renal insufficiency defined as CrCl 5080 mL/min (RR 0.80 [95% CI 0.660.96], P=0.02) and similar in patients with moderate to severe renal insufficiency defined as CrCl <50 mL/min (RR 1.01 [95% CI 0.492.10], P=0.97).32, Apixaban is considered Pregnancy Category B and carries an increased risk of hemorrhage during pregnancy and delivery, thus its use is only recommended if the potential benefit outweighs the potential risk to the mother and fetus. Prolongation of these assays is subject to a high degree of variability and should not be used in the routine monitoring of the anticoagulation effect of apixaban. sulindac and apixaban both increase anticoagulation. Patients with a bileaflet aortic valve with major risk factors for stroke, CHADS2 score of 3 or 4, or VTE within the past 312 months or active cancer are intermediate risk (4%10% annual risk of ATE or 4%10% per month risk of VTE). Either increases levels of the other by anticoagulation. alteplase and apixaban both increase anticoagulation. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Based on the mechanism of action, Factor X is likely to be counteracted by direct and indirect Factor Xa inhibitors. eliglustat increases levels of apixaban by P-glycoprotein (MDR1) efflux transporter. Rifampin, a combined P-gp and strong CYP3A4 inducer, may decrease exposure to apixaban. Douketis J, Spyropoulos A, Spencer F, et al. Contraindicated. Serious - Use Alternative (1)celecoxib and apixaban both increase anticoagulation. Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. Avoid or Use Alternate Drug. To date, no published RCTs have addressed the use of reversal agents for apixaban, and current evidence for TSOAC reversal is primarily extrapolated from in vitro experiments and animal models. Ask your doctor or pharmacist about how much alcohol you may safely drink.This medication can cause bleeding. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Contraindicated. Patients were also excluded if they had received more than two doses of a once-daily LMWH, fondaparinux, or a VKA; more than three doses of twice-daily LMWH; more than 36 hours of continuous intravenous heparin; hemoglobin less than 9 mg/dL, platelet count less than 100,000/mm3, serum creatinine >2.5 mg/dL, or calculated CrCl <25 mL/min. Siegal DM. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. By clicking send, you acknowledge that you have permission to email the recipient with this information. Avoid or Use Alternate Drug. 8600 Rockville Pike elagolix will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Although clarithromycin is a combined P-gp and strong CYP3A4 inhibitor, the manufacturer has stated that pharmacokinetic data suggest that no dose adjustment is necessary with concomitant administration. Melatonin may decrease prothrombin time. Kyrle PA, Rosendaal FR, Eichinger S. Risk assessment for recurrent venous thrombosis. Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively termed venous thromboembolism (VTE), results in significant morbidity and mortality. Monitor Closely (1)sertraline and apixaban both increase anticoagulation. Use Caution/Monitor. Monitor Closely (1)lonafarnib will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. May increase risk of bleeding. Anti-thrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Apixaban is currently FDA-approved to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, for the prophylaxis of DVT, which may lead to PE, in patients who have undergone TKR or THR, for the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following initial therapy. Your doctor may need to check you for hidden bleeding that could be serious.During pregnancy, this medication should be used only when clearly needed. efavirenz will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)dipyridamole and apixaban both increase anticoagulation. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding. Use Caution/Monitor. Ansell JE, Bakhru SH, Laulicht BE, et al. Monitor CYP3A substrates if coadministered. Contraindicated. encorafenib, apixaban. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents; patients requiring anticoagulation while on imatinib should receive LMWH or unfractionated heparin instead of warfarin because of multiple interaction mechanisms of imatinib with warfarin. Avoid or Use Alternate Drug. Accessibility Monitor Closely (1)efavirenz will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Apixaban pharmacokinetics and pharmacodynamics13,1517. The AMPLIFY trial was a randomized double-blind study that compared the efficacy and safety of apixaban (10 mg twice daily for 7 days followed by 5 mg twice daily) with subcutaneous enoxaparin 1 mg/kg every 12 hours for at least 5 days followed by warfarin (goal INR 23) in a total of 5,395 patients with acute VTE.24 Treatment in both arms was for 6 months. Avoid or Use Alternate Drug. Patients were randomized to 5, 10, or 20 mg once daily of apixaban or placebo for 12 weeks within 4 weeks of the start of chemotherapy. Avoid or Use Alternate Drug. lonafarnib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. sertraline and apixaban both increase anticoagulation. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Avoid or Use Alternate Drug. bivalirudin and apixaban both increase anticoagulation. US residents can call their local poison control center at 1-800-222-1222. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol. Use Caution/Monitor. Douxfils J, Chatelain C, Chatelain B, Dogne JM, Mullier F. Impact of apixaban on routine and specific coagulation assays: a practical laboratory guide. Contraindicated. Monitor Closely (1)diltiazem increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. The Surgeon Generals Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Table 5 addresses risk stratification and recommendations regarding perioperative bridging anticoagulation. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs. Patients with renal impairment receiving apixaban with drugs that are combined P-gp and weak or moderate CYP3A4 inhibitors may have significant increases in exposure compared with patients with normal renal function and no inhibitor use, since both pathways of apixaban elimination are affected. Historically, parenteral anticoagulants have been utilized to include unfractionated heparin (UFH), low molecular weight heparin (LMWH), and the indirect anti-factor Xa inhibitor fondaparinux. Avoid or Use Alternate Drug. Monitor Closely (1)tazemetostat will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. In the AMPLIFY-EXT study, Agnelli et al further evaluated the use of apixaban for extended prophylaxis following initial treatment for VTE.25 This randomized double-blind trial compared two doses of apixaban (2.5 mg and 5 mg, twice daily) with placebo in patients with VTE who had completed 612 months of anticoagulation therapy. Avoid or Use Alternate Drug. primidone will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. antithrombin alfa and apixaban both increase anticoagulation. Modify Therapy/Monitor Closely. Serious - Use Alternative (1)apalutamide will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. dabigatran and apixaban both increase anticoagulation. Either increases effects of the other by anticoagulation. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. Monitor Closely (1)iloperidone increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Promptly evaluate any signs or symptoms of blood loss if treated concomitantly with low-dose aspiriin. Take your next dose at the regular time. Avoid or Use Alternate Drug. It was also demonstrated that activated protein C resistance will be affected at higher concentrations of apixaban, and the intrinsic and extrinsic clotting factor assays were affected by the presence of apixaban. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. The Avoid or Use Alternate Drug. Surgery and invasive procedures in patients on long-term treatment with direct oral anticoagulants: thrombin or factor-Xa inhibitors. lorlatinib will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. The elimination half-life is prolonged in renal impairment.13,1517 Additional pharmacokinetic details are delineated in Table 1. Monitor Closely (1)ibrutinib will increase the level or effect of apixaban by anticoagulation. idelalisib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. Nintedanib is a VEGFR inhibitor, and may increase the risk of bleeding; monitor patients on full anticoagulation therapy; monitor closely for bleeding and adjust therapy as needed . Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid combined use once INR is established in the desired therapeutic range. In the ADVANCE-1 trial, apixaban 2.5 mg daily was compared to enoxaparin 30 mg subcutaneous twice daily.19 Both medications were initiated 12 hours following surgery. This drug is available at a middle level co-pay. Kahn S, Lim W, Dunn A, et al. The ADVANCE-1 and ADVANCE-2 trials were large Phase III clinical trials that evaluated apixaban following TKR for 1014 days. Both were designed as noninferiority trials. Use Caution/Monitor. Serious - Use Alternative (1)ketoprofen and apixaban both increase anticoagulation. Although warfarin has been utilized for over 60 years, it has several limitations, including a slow onset of action, a narrow therapeutic window requiring routine international normalized ratio (INR) monitoring, lack of predictable anticoagulant effect by drug dose, and multiple factors that influence absorption such as drugdrug interactions, altered metabolism due to genetic variations, altered vitamin K balance, impaired liver function, and hypermetabolic states such as fever or hyperthyroidism.610 In the last 5 years, four new target-specific oral anticoagulants (TSOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, have been approved for various indications.1114 The advantages of these TSOACs are the lack of need for routine laboratory monitoring, a rapid onset of action with a predictable anticoagulant effect, once or twice daily fixed dosing, and low potential for food and drug interactions. Use of PER977 to reverse the anticoagulant effect of edoxaban. However, when compared to aspirin, the risk for intracranial hemorrhage is similar with apixaban (RR 0.84 [95% CI 0.381.87], P=0.67).38 Further, a recent meta-analysis showed that apixaban is associated with a lower risk of composite bleeding (including major or CRNM bleeding) and intracranial bleeding than VKAs.39 In the ARISTOTLE trial, there were fewer intracranial hemorrhages with apixaban compared to warfarin (hazard ratio 0.42 [95% CI 0.300.58], P<0.001).40 Unlike VKAs such as warfarin, in which Vitamin K or fresh frozen plasma has been historically utilized, or UFH in which protamine is an effective antidote, no direct reversal agent exists for apixaban.13,41 Thus, bleeding complications pose a unique challenge. Do not double the dose to catch up. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Avoid or Use Alternate Drug. The authors report no conflicts of interest in this work. The above information is provided for general posaconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as hematocrit/hemoglobin, red blood cell count) may be performed periodically to monitor your progress or check for side effects. apixaban, zanubrutinib. Clinically relevant nonmajor bleeding (2.08%, warfarin 3.0%; P <0.0001), Hypersensitivity reactions (including skin rash and anaphylactic reactions such as allergic edema), Blood and lymphatic system disorders: Thrombocytopenia (including platelet count decreases), Vascular disorders: Hypotension (including procedural hypotension), Respiratory, thoracic, and mediastinal disorders: Epistaxis, Gastrointestinal disorders: Gastrointestinal hemorrhage (including hematemesis and melena), hematochezia, Hepatobiliary disorders: Liver function test abnormal, blood alkaline phosphatase increased, blood bilirubin increased, Renal and urinary disorders: Hematuria (including respective laboratory parameters), Injury, poisoning, and procedural complications: Wound secretion, incision-site hemorrhage (including incision-site hematoma), operative hemorrhage, Severe hypersensitivity (ie, anaphylactic reactions), Discontinuing apixaban in the absence of adequate alternative anticoagulation increases the risk of thrombotic events (see Black Box Warnings), Risk of epidural or spinal hematoma when used with neuraxial anesthesia (see Black Box Warnings), Safety and efficacy has not been studied in patients with prosthetic heart valves; therefore, use of is not recommended in these patients, Not recommended as an alternative to unfractionated heparin for the initial treatment of PE in patients who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy, Coadministration with strong dual inhibitors of CYP3A4 and P-gp (see Dosage Modifications), Avoid coadministration with strong dual inducers of CYP3A4 and P-gp; such drugs decrease apixabans systemic exposure, Increases the risk of bleeding and can cause serious, potentially fatal, bleeding; advise patients of signs and symptoms of blood loss and to report them immediately or go to an emergency room; discontinue therapy in patients with active pathological hemorrhage, Coadministration with other drugs that affect hemostasis increases bleeding risk (eg, aspirin and other antiplatelet agents, other anticoagulants, heparin, thrombolytic agents, SSRIs, SNRIs, NSAIDs), Prolongs PT and aPTT; however, changes are small and highly variable and are not useful for monitoring anticoagulation effect of apixaban, Direct-acting oral anticoagulants (DOACs), are not recommended for use in patients with triple-positive antiphospholipid syndrome (APS); for patients with APS (especially those who are triple positive [positive for lupus anticoagulant, anticardiolipin, and antibeta 2- glycoprotein I antibodies]), treatment with DOACs has been associated with increased rates of recurrent thrombotic events compared with vitamin K antagonist therapy, There are no adequate and well-controlled studies in pregnant women, Treatment is likely to increase the risk of hemorrhage during pregnancy and delivery, Use of anticoagulants, during pregnancy, may increase risk of bleeding in fetus and neonate, Pregnancy confers an increased risk of thromboembolism that is higher for women with underlying thromboembolic disease and certain high-risk pregnancy conditions, Published data describe that women with a previous history of venous thrombosis are at high risk for recurrence during pregnancy, Therapy should be administered during pregnancy only if the potential benefit outweighs the potential risk to the mother and fetus, There are no data on presence of drug metabolites in human milk, effects on breastfed child, or the effects on milk production; the drug and/or its metabolites were present in milk of rats, Rats excrete apixaban in milk (12% of the maternal dose), Because human exposure through milk is unknown, instruct women to either discontinue breastfeeding or to discontinue apixaban therapy, taking into account the importance of the drug to the mother.
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