Apixaban Disease Interactions

The use of factor Xa inhibitors is contraindicated in patients with active pathological bleeding as these agents increase the risk of bleeding and can cause serious or fatal hemorrhages. Caution is recommended when prescribing factor Xa inhibitors to patients at increased risk of bleeding, including patients undergoing procedures where bleeding may cause serious complications. Such patients include those undergoing spinal/epidural anesthesia or spinal puncture; these patients are at high risk of an epidural or spinal hematoma, which can result in long-term or permanent paralysis. In general, when using factor Xa inhibitors, the risk of thrombotic events should be weighed against the risk of bleeding.

The use of factor Xa inhibitors (including apixaban and edoxaban) is not recommended in patients with moderate or severe liver dysfunction (Child-Pugh B or C) as these patients may have intrinsic coagulation abnormalities.

The use of some factor Xa inhibitors (including apixaban, edoxaban, and rivaroxaban) is not recommended in patients with prosthetic heart valves; safety and efficacy have not been established in such patients.

Direct acting oral anticoagulants including factor Xa inhibitors and some thrombin inhibitors as dabigatran, are not recommended for use in patients with antiphospholipid syndrome (APS). Treatment with these drugs has been associated with increased rates of recurrent thrombotic events, especially in patients with triple positive APS.