Do you need to pause apixaban (Eliquis) when drawing labs from a port?

Drawing Labs from a Port While on Apixaban (Eliquis)

You do not need to pause apixaban (Eliquis) when drawing blood samples from a port. Drawing blood from a port is considered a minimal bleeding risk procedure that does not require interruption of anticoagulation therapy.

Rationale for Continuing Apixaban During Port Access

The American College of Chest Physicians guidelines recommend continuing direct oral anticoagulants (DOACs) like apixaban for minor procedures with minimal bleeding risk 1. Blood draws from ports fall into this category, similar to minor dental procedures which also do not require DOAC interruption.

Key considerations:

• Port access for blood draws is a minimally invasive procedure with very low bleeding risk
• Interrupting anticoagulation unnecessarily increases thrombotic risk
• The 2021 ACC expert consensus pathway supports continuing anticoagulation for minor procedures 1

Important Considerations When Drawing Labs While on Apixaban

Timing of Blood Draw

• If specific coagulation tests are being drawn, note that apixaban can affect certain lab values:
  • INR and aPTT results do not correlate with apixaban dosing 2
  • For accurate assessment of apixaban levels, specialized tests are required (anti-Xa assays) 1
  • If coagulation studies are needed, consider drawing the sample just before the next scheduled dose (trough level) 1

Port Access Technique

• Use proper sterile technique when accessing the port
• Apply gentle pressure after port needle removal
• Monitor the site for 5-10 minutes after needle removal to ensure hemostasis

When Anticoagulation Interruption IS Required

While port access does not require interruption, it's important to recognize when apixaban should be paused:

• For high bleeding risk procedures like transfemoral PCI: 48 hours if CrCl ≥30 mL/min; 72 hours if CrCl <29 mL/min 1
• For transradial PCI: 24 hours if CrCl ≥30 mL/min; 36 hours if CrCl 15-29 mL/min 1
• For major surgeries: 48 hours before procedure if normal renal function 1

Special Populations

For patients with renal impairment, advanced age, or low body weight, standard apixaban dosing may be adjusted (2.5 mg twice daily instead of 5 mg twice daily) 3, 4, but this does not affect the recommendation to continue apixaban during port access for blood draws.

Conclusion

Blood draws from ports can be safely performed without interrupting apixaban therapy. This approach minimizes thrombotic risk while maintaining the safety profile of this minimally invasive procedure.