From the Guidelines
Patients should typically discontinue Eliquis (apixaban) at least 48 hours before undergoing CABG (coronary artery bypass graft) surgery, as the half-life of apixaban is approximately 12 hours, and stopping the medication 48 hours prior to surgery is generally sufficient to reduce bleeding risk [ 1 ].
Key Considerations
- For patients with normal renal function, stopping Eliquis 48 hours prior to surgery is generally sufficient to reduce bleeding risk.
- However, patients with impaired kidney function may need to stop the medication earlier, potentially, as the timing of discontinuation may vary according to the particular agent and patient renal function [ 1 ].
- The timing should be individualized based on the patient's specific bleeding risk factors, renal function, and the urgency of the surgery.
Post-Surgery Recommendations
- After surgery, Eliquis can typically be resumed once adequate hemostasis is achieved, usually within 48-72 hours post-operation, but this decision should be made by the surgical team.
- During this perioperative period, some patients may require bridging anticoagulation with shorter-acting agents depending on their thrombotic risk.
Rationale
- The recommendation to stop Eliquis before CABG surgery is based on its pharmacokinetic profile, with a half-life of approximately 12 hours in most patients, meaning that after 48 hours (about 4 half-lives), the anticoagulant effect is substantially reduced to minimize surgical bleeding complications [ 1 ].
- According to the provided evidence, for patients on an NOAC, such as apixaban, therapy should be withheld for 24 hours (or 48 hours for patients with impaired renal function with dabigatran), irrespective of vascular access site [ 1 ].
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
- Discontinuation time: At least 48 hours
- Surgery type: Elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding, such as CABG surgery A patient should be off of Eliquis (apixaban) for at least 48 hours before undergoing CABG surgery 2.
From the Research
Eliquis Discontinuation Before CABG Surgery
- The provided studies do not directly address the discontinuation of Eliquis before CABG surgery.
- However, studies 3 and 4 discuss the effects of preoperative administration of enoxaparin and unfractionated heparin on bleeding indices in patients undergoing coronary artery bypass grafting (CABG).
- Study 4 suggests that the preoperative use of enoxaparin less than 12 hours before CABG is associated with lower postoperative hemoglobin values and higher rates of transfusion than continuous unfractionated heparin.
- It is essential to note that Eliquis (apixaban) is a direct oral anticoagulant, and its discontinuation protocol may differ from that of heparins.
- There are no research papers provided that directly assist in answering the question of how many days a patient should be off of Eliquis before undergoing CABG surgery 3, 4, 5, 6, 7.