What is the recommended dose of Eliquis (apixaban) after a hip procedure?

Apixaban Dosing After Hip Procedure

For venous thromboembolism (VTE) prophylaxis after hip replacement surgery, the recommended dose of Eliquis (apixaban) is 2.5 mg taken orally twice daily for 5 weeks. 1, 2

Dosing Regimen Details

• Dose: 2.5 mg twice daily 2
• Initial timing: First dose should be taken 12 to 24 hours after surgery 2
• Duration: 5 weeks (35 days) for total hip replacement (THR) 1, 2
• Administration: Oral tablets, taken approximately 12 hours apart 2

Perioperative Management

Preoperative Discontinuation

If a patient is already on apixaban and requires hip surgery:

• Discontinue apixaban at least 48 hours prior to elective surgery with moderate or high bleeding risk 2
• Discontinue apixaban at least 24 hours prior to procedures with low bleeding risk 2
• For neuraxial anesthesia (spinal/epidural), longer interruption times up to five days may be needed 1

Postoperative Resumption

• Resume apixaban when adequate hemostasis has been established 2
• If venous thromboprophylaxis is indicated immediately post-surgery, heparin (UFH or LMWH) or fondaparinux can be administered at least six hours after the procedure 1
• Therapeutic anticoagulation can usually be resumed between 24 and 72 hours postoperatively 1
• If an epidural catheter is present, therapeutic anticoagulation should be administered with heparin until safe catheter removal 1

Special Considerations

• Renal function: Monitor creatinine clearance postoperatively as surgical procedures may affect renal function 1
• Bleeding risk: Consider individual bleeding risk when determining timing of first dose 1
• Concomitant medications: Be aware of potential drug interactions, particularly with P-glycoprotein inhibitors and CYP3A4 inhibitors which may increase apixaban concentrations 1
• Missed doses: If a dose is missed, take it as soon as possible on the same day and resume twice-daily dosing; do not double the dose 2

Efficacy and Safety

• Apixaban has demonstrated effectiveness in preventing VTE after major orthopedic surgery 3
• In clinical trials (ADVANCE-2 and ADVANCE-3), apixaban 2.5 mg twice daily was more effective than enoxaparin 40 mg once daily in preventing VTE in patients undergoing knee or hip replacement surgery, without significantly increasing bleeding risk 3, 4
• Recent evidence suggests apixaban has a comparable efficacy profile to enoxaparin with potentially better safety profile 5

Common Pitfalls to Avoid

• Inadequate duration: Not continuing prophylaxis for the full recommended 5 weeks after hip replacement 1
• Improper timing: Starting too early (increased bleeding risk) or too late (increased thrombosis risk) 2
• Failure to adjust for patient factors: Not considering renal function, age, weight, or concomitant medications 1
• Overlapping anticoagulants: When transitioning between anticoagulants, avoid overlapping to prevent excessive anticoagulation 1
• Improper management with epidural catheters: Special care must be taken with timing of apixaban administration when epidural anesthesia is used 1

Remember that monitoring creatinine clearance is important as renal function may change postoperatively, potentially affecting apixaban dosing and safety 1.