From the Guidelines
It is not safe to take Eliquis (apixaban) on the day of pleurodesis, and it should be stopped at least 48 hours before the procedure. According to the suggested management approach for preoperative interruption of new oral anticoagulants, such as apixaban, patients with normal or mild renal impairment should stop taking the medication 2 days before surgery, skipping 2 doses, for low bleeding risk surgeries, and 3 days before surgery, skipping 4 doses, for high bleeding risk surgeries 1. Pleurodesis is a procedure that carries a risk of bleeding, and the anticoagulant effects of Eliquis would increase this risk.
The decision to stop and restart Eliquis should be based on individual circumstances, including the reason for taking the anticoagulant, kidney function, and overall bleeding risk. The healthcare provider should balance the thrombotic risk against the bleeding risk when planning the timing around the pleurodesis procedure.
Some key points to consider:
- Apixaban has a half-life of 7-8 hours, and its effects can be significant in the context of a surgical procedure like pleurodesis 1.
- The suggested approach for postoperative resumption of apixaban is to resume the medication 2-3 days after surgery, at a dose of 5 mg twice daily, for high bleeding risk surgeries 1.
- It is essential to follow the healthcare provider's instructions regarding the timing of stopping and restarting Eliquis, as this will depend on individual factors and the specific procedure being performed.
In general, the management of anticoagulation in patients undergoing pleurodesis should prioritize minimizing the risk of bleeding while also considering the risk of thromboembolic events. This requires careful planning and monitoring by the healthcare team, taking into account the patient's individual circumstances and the specific procedure being performed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Safety of Taking Eliquis on the Day of Pleurodesis
- The decision to take Eliquis (apixaban) on the day of pleurodesis depends on the balance between the risk of bleeding associated with the anticoagulant therapy and the risk of arterial thrombosis due to its interruption 2.
- A study published in the Journal of Managed Care & Specialty Pharmacy found that apixaban was associated with a lower risk of major bleeding compared to warfarin and rivaroxaban 3.
- However, another study published in the Canadian Journal of Anesthesia found that antiplatelet agents, including acetylsalicylic acid and clopidogrel, can increase the risk of bleeding during surgery, and that the management of antiplatelet agent-treated patients undergoing surgery is not well established 4.
- A review of the literature on apixaban found that bleeding is a significant adverse event associated with anticoagulant therapy, and that prolonged use of apixaban can increase the risk of bleeding 5.
- A sub-analysis of the AMPLIFY trial found that the risk of recurrent thromboembolism and bleeding during apixaban therapy was highest during the first weeks of treatment, but that apixaban was associated with a reduced bleeding risk compared to conventional therapy with enoxaparin and warfarin 6.
Key Findings
- Apixaban is associated with a lower risk of major bleeding compared to warfarin and rivaroxaban 3.
- Antiplatelet agents can increase the risk of bleeding during surgery, and the management of antiplatelet agent-treated patients undergoing surgery is not well established 4.
- Prolonged use of apixaban can increase the risk of bleeding 5.
- The risk of recurrent thromboembolism and bleeding during apixaban therapy is highest during the first weeks of treatment 6.