From the Guidelines
For percutaneous drainage procedures, Eliquis (apixaban) should typically be held for 48 hours (2 days) before the procedure in patients with normal renal function, and for 72 hours (3 days) in patients with impaired renal function, as recommended by the most recent guidelines 1. This recommendation is based on the pharmacokinetics of apixaban, which has a half-life of 12 hours in patients with normal renal function, and is partially eliminated through the kidneys. In patients with impaired renal function, the clearance of apixaban is delayed, necessitating a longer discontinuation period. The decision to hold anticoagulation should always be balanced against the patient's risk of thromboembolism, and in some high-risk patients, the holding period might need to be modified in consultation with the proceduralist. Some key points to consider when managing anticoagulation in patients undergoing percutaneous drainage procedures include:
- The timing of the last dose of apixaban before the procedure, which should be at least 48 hours for patients with normal renal function, and 72 hours for patients with impaired renal function 1.
- The use of bridging anticoagulation, which is generally not required for most patients on apixaban, but may be considered in high-risk patients 1.
- The resumption of apixaban after the procedure, which can usually be done 24-48 hours after the intervention, if adequate hemostasis has been achieved 1. It is essential to individualize the management of anticoagulation in each patient, taking into account their specific clinical characteristics, such as renal function, bleeding risk, and thrombotic risk, as well as the type of procedure being performed. By following these guidelines and considering the individual patient's needs, clinicians can minimize the risk of bleeding and thrombotic complications in patients undergoing percutaneous drainage procedures while on apixaban therapy.
From the Research
Eliquis (Apixaban) Hold Time Before Percutaneous Drainage
- The hold time for Eliquis (apixaban) before percutaneous drainage is not explicitly stated in the provided studies, but we can look at the pharmacokinetics and clinical trials for guidance.
- 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 a surgical procedure 2.
- Another study on the pharmacokinetics of apixaban in patients on hemodialysis found that apixaban exposure is dependent on both drug dose and timing of intake relative to the hemodialysis procedure 3.
- However, none of the provided studies specifically address the hold time for Eliquis before percutaneous drainage in patients with normal or impaired renal function.
- Based on the available data, it is recommended to hold Eliquis for at least 48 hours before percutaneous drainage, but this may vary depending on individual patient factors and renal function 2.
Renal Function Considerations
- Patients with impaired renal function may require closer monitoring and potentially longer hold times due to altered apixaban pharmacokinetics 4, 5, 3.
- A study on apixaban in patients with atrial fibrillation on hemodialysis found that apixaban exposure was dependent on both drug dose and timing of intake relative to the hemodialysis procedure 3.
- Another study found that apixaban may be a reasonable alternative to warfarin in patients with severe renal dysfunction, but the hold time before percutaneous drainage was not addressed 4.
Clinical Trials and Guidelines
- The RENAL-AF trial, a multicenter randomized controlled trial, evaluated the safety and efficacy of apixaban in patients with atrial fibrillation on hemodialysis, but did not provide guidance on hold times before percutaneous drainage 6.
- Clinical guidelines and trials may provide additional guidance on the management of anticoagulation in patients undergoing percutaneous drainage, but were not included in the provided studies.