How long to hold Eliquis (apixaban) before EGD with severe impaired renal function?

From the Guidelines

Holding Eliquis (Apixaban) before EGD with Severe Impaired Renal Function

Patients with severe impaired renal function should hold Eliquis (apixaban) for at least 4 days prior to an esophagogastroduodenoscopy (EGD) procedure.

• The specific duration of hold may vary depending on the patient's renal function and the clinical context, but a general guideline is to withhold Eliquis for at least 96 hours before the EGD, as suggested by guidelines for patients with severe renal impairment 1.
• For patients taking the standard dose of 5mg twice daily, this would translate to holding the medication for 4 days, with the last dose administered 96 hours before the procedure.
• It is essential to consider the patient's renal function, as those with severe impairment (CrCl <30 mL/min) may require a longer duration of hold due to the increased risk of bleeding and the prolonged half-life of apixaban in this population 1.
• The decision to hold Eliquis should be made in consultation with a healthcare provider, taking into account the individual patient's risk factors and the specific procedure being performed.
• In cases where the patient's renal function is rapidly deteriorating, consultation with a hematologist is recommended to determine the best course of action 1.

From the FDA Drug Label

Apixaban has a total clearance of approximately 3. 3 L/hour and an apparent half-life of approximately 12 hours following oral administration. Renal excretion accounts for about 27% of total clearance. No dose adjustment is recommended for nonvalvular atrial fibrillation patients unless at least 2 of the following patient characteristics (age greater than or equal to 80 years, body weight less than or equal to 60 kg, or serum creatinine greater than or equal to 1. 5 mg/dL) are present.

The FDA drug label does not provide a specific recommendation for holding Eliquis (apixaban) before an EGD (esophagogastroduodenoscopy) with severe impaired renal function. However, considering the half-life of approximately 12 hours, it would be prudent to hold apixaban for at least 2-3 half-lives (24-36 hours) before the procedure to minimize the risk of bleeding, especially in patients with severe impaired renal function. This is a conservative approach, as the label does not provide direct guidance on this specific scenario 2.

From the Research

Holding Eliquis (Apixaban) Before EGD with Severe Impaired Renal Function

There are no direct research papers that provide guidance on how long to hold Eliquis (apixaban) before an Esophagogastroduodenoscopy (EGD) with severe impaired renal function. However, the following information may be relevant:

• The management of patients with impaired renal function often requires dose adjustment of certain medications to prevent adverse events 3.
• The estimation of glomerular filtration rate (GFR) is crucial in assessing kidney function, and various predictive equations can be used, including the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation 4.
• The CKD-EPI equation is considered the most accurate creatinine-based method for estimating GFR in routine practice 4.
• In patients with cancer undergoing cisplatin-based chemotherapy, estimation of GFR by the CKD-EPI formula (eGFR) is considered sufficient for assessing kidney function 5.
• The use of eGFR and urinary albumin-to-creatinine ratio (UACR) can help identify patients with diabetic kidney disease (DKD) 6.

Key Considerations

• Patients with severe impaired renal function may require closer monitoring and dose adjustment of medications, including anticoagulants like Eliquis (apixaban) 3, 7.
• The choice of GFR estimation method may depend on the individual patient's characteristics and the clinical setting 7, 5.
• It is essential to consider the potential risks and benefits of holding or continuing anticoagulation therapy in patients with severe impaired renal function undergoing EGD.

Relevant Factors

• The patient's underlying renal function and estimated GFR
• The presence of other comorbidities, such as diabetes or cardiovascular disease
• The type and duration of anticoagulation therapy
• The clinical indication for EGD and the potential risks of bleeding or thrombosis.