When is it appropriate to restart Eliquis (apixaban) following an L1 kyphoplasty?

From the Guidelines

Eliquis (apixaban) can typically be restarted as early as 6 hours postoperatively after an L1 kyphoplasty, provided there are no signs of bleeding complications and hemostasis has been achieved, as peak levels and a therapeutic anticoagulation effect are achieved in ∼2 to 3 hours with DOACs 1. When considering the resumption of Eliquis after an L1 kyphoplasty, several factors must be taken into account to balance the risk of thrombotic events against the risk of bleeding complications.

• The patient's overall health status and specific risk factors for bleeding or thrombosis, such as age, renal function, history of bleeding, and concomitant medications, should be evaluated.
• The procedure itself, being a kyphoplasty, involves risks associated with needle insertion and cement placement that could potentially lead to bleeding if anticoagulation is resumed too early.
• Guidelines suggest that for most patients, resuming DOACs like Eliquis as early as 6 hours post-procedure may be appropriate if hemostasis has occurred, considering the rapid achievement of peak levels and therapeutic effect with these medications 1. However, the decision to restart Eliquis should be individualized and made in consultation with both the interventional radiologist or spine surgeon who performed the procedure and the physician who prescribed the anticoagulant, taking into account the specific clinical context and the patient's risk profile.
• For patients at higher risk of bleeding, waiting 24 hours or more before restarting anticoagulation may be prudent, although this should be balanced against the risk of thrombotic events.
• It's also worth noting that while specific guidance for kyphoplasty procedures may not be extensively detailed in all guidelines, the general principles for managing anticoagulation in the perioperative period can be applied, with an emphasis on careful patient selection and monitoring 1.

From the FDA Drug Label

Apixaban tablets should be restarted after the surgical or other procedures as soon as adequate hemostasis has been established [see Warnings and Precautions (5. 2)].

The appropriate time to restart Eliquis (apixaban) following an L1 kyphoplasty is as soon as adequate hemostasis has been established 2.

From the Research

Restarting Eliquis after L1 Kyphoplasty

• There is no direct evidence in the provided studies regarding the appropriate timing for restarting Eliquis (apixaban) after an L1 kyphoplasty.
• However, the studies provide information on the use of apixaban in patients with atrial fibrillation and its efficacy in preventing stroke or systemic embolism 3, 4, 5, 6.
• Kyphoplasty is a procedure used to treat vertebral compression fractures, and the decision to restart anticoagulation therapy after such a procedure should be based on the patient's individual risk factors and medical history 7.
• The studies suggest that apixaban can be an effective and safe alternative to other anticoagulants, such as warfarin, in patients with atrial fibrillation 4, 5.
• However, the risk of bleeding should be carefully considered when restarting anticoagulation therapy after a procedure like kyphoplasty.
• The timing of restarting Eliquis after an L1 kyphoplasty should be determined by a healthcare professional, taking into account the patient's overall health status, the reason for the kyphoplasty, and the risk of bleeding or other complications.

Considerations for Restarting Anticoagulation Therapy

• The decision to restart anticoagulation therapy after a kyphoplasty procedure should be based on a careful assessment of the patient's individual risk factors and medical history.
• The patient's risk of stroke or systemic embolism should be weighed against the risk of bleeding or other complications associated with anticoagulation therapy.
• The healthcare professional should consider the patient's overall health status, the reason for the kyphoplasty, and the results of any relevant diagnostic tests when making a decision about restarting anticoagulation therapy.
• The patient should be closely monitored for any signs of bleeding or other complications after restarting anticoagulation therapy.