There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
The FDA Drug Labels for apixaban (PO) do not address this question.
From the Research
Apixaban Hold Time Before Thoracentesis
- The hold time for apixaban before thoracentesis is not explicitly stated in the provided studies, but we can look at the pharmacokinetics of apixaban and its effects on bleeding risk to inform our understanding.
- Apixaban has a half-life of approximately 12 hours, with a rapid absorption and maximum concentration occurring 3-4 hours after oral administration 1.
- A study on apixaban discontinuation for invasive or major surgical procedures found that holding apixaban for at least 48 hours before a procedure resulted in a clinically insignificant degree of anticoagulation prior to the procedure 2.
- Another study on the safety of thoracentesis in patients with uncorrected bleeding risk found that thoracentesis may be safely performed without prior correction of coagulopathy, thrombocytopenia, or medication-induced bleeding risk, including apixaban 3.
- However, there have been reports of spontaneous hemothorax as a complication of apixaban treatment, highlighting the importance of careful consideration of bleeding risk when performing invasive procedures like thoracentesis 4.
- A consensus guide on the practical management of patients on apixaban recommends temporary interruption of apixaban for elective procedures, but does not provide specific guidance on the hold time before thoracentesis 5.