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Eliquis® (apixaban)

Risk Minimisation Information for Healthcare Professionals

Using apixaban before surgery and invasive procedures1,2,3

Apixaban should be discontinued prior to elective surgery or invasive procedures (excluding cardioversion or catheter ablation) with a risk of bleeding (see table below).

high risk of bleeding

If surgery or invasive procedures cannot be delayed, exercise appropriate caution, taking into consideration an increased risk of bleeding. This risk of bleeding should be weighed against the urgency of intervention.

In the event a patient treated with apixaban requires an elective procedure, such as surgery or an invasive procedure associated with an increased risk of bleeding, apixaban should be discontinued for a sufficient period of time prior to the procedure to reduce the risk of anticoagulant-related bleeding. The half-life of apixaban is approximately 12 hours. Given that apixaban is a reversible factor Xa inhibitor, its anticoagulant activity should abate within 24 to 48 hours from the last administered dose.

Discontinuation of apixaban prior to elective surgery/invasive procedure

Low risk of bleeding (includes interventions for which bleeding, if it occurs, will be minimal, non-critical in its location and/or easily controlled by simple mechanical haemostasis)

At least 24 hours prior to elective surgery or invasive procedure

Moderate or high risk of bleeding (includes interventions for which the probability of clinically significant bleeding cannot be excluded, or for which the risk of bleeding would be unacceptable)

At least 48 hours prior to elective surgery or invasive procedure

This Prescriber Guide is not a substitute for the apixaban Summary of Product Characteristics (SmPC). Please consult the SmPC for full prescribing information.