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Apixaban: Indications, Drug Interactions & Side Effects

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson defines and explains the major uses of a medication known as apixaban. You'll also learn about some of its important drug interactions and critical side effects.

What is Apixaban?

Apixaban is a factor Xa inhibitor. In more simple terms it's an anticoagulant or a type of blood thinner. It's better known by its trade name of Eliquis. This oral medication is one of a newer generation of blood thinners when compared to the more famous but also potentially more dangerous warfarin. Warfarin, better known as Coumadin, is a blood thinner that's still used in rat poison to this day!

But this lesson isn't about the comparisons of safety and efficacy of apixaban vs. warfarin. Instead, it goes over the major indications, drug interactions, and side-effects of apixaban.

Indications

Apixaban has three major indications, or major uses.

First, it's used in people who have nonvalvular atrial fibrillation to reduce the chances they will have a stroke or a blood clot in their arteries in general. Atrial fibrillation is one of the most common types of heart arrhythmias, especially in the elderly. By 'nonvalvular' atrial fibrillation, this generally refers to people with atrial fibrillation who do not have artificial heart valves or heart valve disease.

Secondly, apixaban is used to minimize the chances that deep vein thrombosis (DVT) or pulmonary embolism (PE) will occur in people who have undergone hip or knee replacement surgery. After such a surgical procedure, a person is at risk of forming blood clots in the deep veins of their legs, something known as deep vein thrombosis.

DVT, by itself, is not a major threat to the person in terms of major disability. However, DVT can lead to PE. If a piece of a blood clot in the deep vein of a leg breaks off and travels to the lungs, it will get stuck in the lungs. This situation is known as a pulmonary embolism. PE can lead to difficulty breathing and, in some cases, death. We'd want to avoid that, right?

Finally, apixaban is suggested for the treatment (not just prevention) of DVT and PE, and it's used to reduce the risk of repeat DVT or PE in people who've had either in the past.

Drug Interactions

As with any drug, apixaban may have important drug interactions that either decrease its important effectiveness or increase the chances of a major side effect. For example, if taken with a drug called carbamazepine, apixaban's effectiveness will be decreased. This means a person will be at greater risk of stroke, DVT, or PE. Carbamazepine is used to treat seizures.

On the flipside, if used in people who are taking defibrotide, the effects of apixaban will be increased. This increases the chances of major side-effects, like serious bleeding. Defibrotide break apart blood clots.

Other drugs which have very similar serious interactions with apixaban include:

  • Dexamethasone
  • Fosphenytoin
  • Rifabutin
  • Rifampin
  • Warfarin
  • St. John's Wort

This list is not exhaustive! Patients should always consult with their physician or pharmacist before starting a new medication to avoid any allergic reactions or serious health complications. Everyday medications like fish oil and aspirin should also be checked for any potential negative interaction.

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