How long should Nasogastric Tube (NGT) suction be held after the last dose of Eliquis (apixaban)?

Nasogastric Tube Suction After Eliquis Administration

Nasogastric tube (NGT) suction should be held for at least 6 hours after administration of Eliquis (apixaban) to ensure proper drug absorption and maintain therapeutic anticoagulation levels. 1

Rationale for Holding NGT Suction

When administering Eliquis to patients with nasogastric tubes, several considerations must be taken into account:

• Absorption concerns: Apixaban requires adequate time in the gastrointestinal tract for proper absorption
• Risk of drug removal: Premature suction could remove unabsorbed medication, leading to subtherapeutic anticoagulation levels
• Bleeding vs. thrombosis risk: Inadequate anticoagulation increases thrombosis risk, while excessive anticoagulation increases bleeding risk

Timing Guidelines Based on Procedure Risk

According to European Society of Cardiology guidelines, the timing for resuming NGT suction after Eliquis administration should follow similar principles as those for resuming anticoagulation after procedures 1:

• Low bleeding risk procedures: Resume 24 hours after procedure
• High bleeding risk procedures: Resume 48-72 hours after procedure

For NGT suction specifically, the minimum recommended hold time is 6 hours after administration to ensure adequate drug absorption.

Administration Considerations for Eliquis via NGT

When administering Eliquis through an NGT:

1. Preparation method: Use mortar/pestle method for crushing tablets to ensure accurate and consistent suspension 2
2. Recommended formulation: 0.25 mg/mL apixaban in 50:50 Ora-Plus:water provides optimal stability and tube compatibility 2
3. Tube compatibility: Both polyurethane and polyvinyl chloride tubes are compatible with properly prepared apixaban suspensions 2
4. Monitoring: Although routine coagulation monitoring is not required for apixaban, high-risk patients (elderly, low body weight, renal impairment) may benefit from anti-factor Xa activity monitoring 3

Important Clinical Considerations

• Tube flushing: Always flush the NGT before and after medication administration to prevent tube obstruction
• Medication timing: Administer Eliquis at consistent times relative to enteral feeding to maintain consistent absorption
• Avoid drug interactions: Hold enteral nutrition for at least 1 hour before and after Eliquis administration to prevent potential interactions
• Documentation: Clearly document the time of Eliquis administration and when NGT suction was held/resumed

Common Pitfalls to Avoid

• Immediate suction: Never resume NGT suction immediately after Eliquis administration
• Improper preparation: Avoid using pill crushers or crushing syringes as they may result in inconsistent dosing 2
• Mixing anticoagulants: Avoid overlapping anticoagulants (e.g., heparin and apixaban) as this increases bleeding risk without additional benefit 1
• Ignoring renal function: Patients with impaired renal function may require longer hold times for NGT suction due to altered drug clearance

By following these guidelines, clinicians can ensure optimal therapeutic effect of Eliquis while minimizing risks associated with both inadequate anticoagulation and excessive bleeding in patients requiring NGT suction.