From the Guidelines
Eliquis (apixaban) should be held for at least 48 hours before a bone marrow biopsy, as recommended by the most recent guidelines 1. This recommendation is based on the pharmacological properties of the drug and the need to balance the risk of bleeding during the procedure with the risk of thrombotic events from stopping anticoagulation. The timing is based on apixaban's half-life of approximately 12 hours, meaning that after 48 hours (about 4 half-lives), only about 6.25% of the drug remains in the system, which significantly reduces bleeding risk while maintaining some anticoagulant effect. However, this recommendation may need adjustment based on individual patient factors such as:
- Renal function: patients with severe renal impairment may need to hold the medication longer
- Bleeding risk: patients at high risk of bleeding may require a longer discontinuation period
- Thrombotic risk: patients at high thrombotic risk might require a shorter discontinuation period or bridging therapy Always consult with the hematologist performing the procedure and the prescribing physician before adjusting any medication regimen. Eliquis can typically be resumed 24 hours after the procedure if adequate hemostasis has been achieved, as suggested by the guidelines 1. It is also important to note that the management of anticoagulation therapy should be individualized and based on the specific clinical scenario, as outlined in the guidelines 1. In general, the decision to hold or continue anticoagulation therapy should be made on a case-by-case basis, taking into account the patient's underlying medical condition, the type of procedure being performed, and the potential risks and benefits of anticoagulation therapy. The guidelines provide a framework for making these decisions, but ultimately, the decision should be made by a healthcare professional with expertise in the management of anticoagulation therapy.
From the FDA Drug Label
Apixaban tablets should be discontinued at least 48 hours prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding The recommended time to hold Eliquis (apixaban) prior to a bone marrow biopsy is at least 48 hours, as it is considered an invasive procedure with a moderate or high risk of bleeding 2.
From the Research
Holding Eliquis Prior to Bone Marrow Biopsy
- There is no specific guidance on holding Eliquis (apixaban) prior to a bone marrow biopsy in the provided studies.
- However, a study on anticoagulation and bone marrow biopsy found that withholding anticoagulation prior to BM biopsy is not routinely recommended 3.
- Instead, assessment and optimization of bleeding risk factors should be done on a patient-by-patient basis 3.
- Other studies compared the safety and efficacy of apixaban with low-molecular-weight heparin or warfarin for venous thromboembolism treatment, but did not provide specific guidance on holding Eliquis prior to a bone marrow biopsy 4, 5, 6.
- A guidance document on peri-procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology may provide useful information, but does not specifically address holding Eliquis prior to a bone marrow biopsy 7.