From the Guidelines
Eliquis (apixaban) should be stopped for at least 1 to 2 weeks after a hematoma, as recommended by the American Heart Association/American Stroke Association council on stroke 1.
Key Considerations
- The anticoagulant effect should be reversed immediately with appropriate agents, such as vitamin K or fresh frozen plasma 1.
- For patients who require anticoagulation soon after a cerebral hemorrhage, intravenous heparin may be safer than oral anticoagulation 1.
- Oral anticoagulants, including Eliquis, may be resumed after 3 to 4 weeks, with rigorous monitoring and maintenance of INRs in the lower end of the therapeutic range 1.
Special Circumstances
- Anticoagulation should not be resumed after a subarachnoid hemorrhage (SAH) until the ruptured aneurysm is definitively secured 1.
- Patients with lobar intracerebral hemorrhages (ICHs) or microbleeds and suspected cerebral amyloid angiopathy (CAA) on MRI may be at a higher risk for recurrent ICH if anticoagulation needs to be resumed 1.
- For patients with hemorrhagic infarction, anticoagulation may be continued, depending on the specific clinical scenario and underlying indication for anticoagulant therapy 1. The decision to resume Eliquis should be individualized, taking into account the patient's risk of thromboembolic events and the potential for bleeding complications 1.
From the FDA Drug Label
Apixaban tablets should be discontinued at least 48 hours prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding [see Warnings and Precautions (5. 2)] . Apixaban tablets should be discontinued at least 24 hours prior to elective surgery or invasive procedures with a low risk of bleeding or where the bleeding would be non-critical in location and easily controlled. Apixaban tablets should be restarted after the surgical or other procedures as soon as adequate hemostasis has been established.
The FDA drug label does not provide specific guidance on how long to stop Eliquis (apixaban) after a hematoma. The label provides guidance on when to stop apixaban before elective surgery or invasive procedures, but it does not address the management of hematomas directly. Therefore, no conclusion can be drawn regarding the duration of apixaban cessation after a hematoma 2.
From the Research
Stopping Eliquis (Apixaban) After a Hematoma
- There is no specific guidance on how long to stop Eliquis (apixaban) after a hematoma in the provided studies 3, 4, 5, 6, 7.
- However, the studies suggest that the decision to stop or continue anticoagulant therapy, including apixaban, should be based on individual patient risk factors and the risk of thromboembolic events 3, 4, 5.
- The American Society of Interventional Pain Physicians (ASIPP) guidelines recommend discontinuing anticoagulant therapy, including apixaban, prior to interventional techniques, with individual consideration of pharmacokinetics and pharmacodynamics of the drugs and individual risk factors 3.
- The guidelines also suggest that if thromboembolic risk is high, low molecular weight heparin bridge therapy can be instituted during cessation of the anticoagulant, and the low molecular weight heparin can be discontinued 24 hours before the pain procedure 3.
- There is fair evidence to make shared decision making between the patient and the treating physicians, considering all the appropriate risks associated with continuation or discontinuation of antithrombotic or anticoagulant therapy 3.
- The optimal duration of apixaban therapy after a hematoma is not specified in the provided studies, and the decision to stop or continue therapy should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 3, 4, 5, 6, 7.