Educational use only. Drug cards are AI-assisted study material for NCLEX preparation.
Mechanism of action
Directly and reversibly inhibits factor Xa in both the free and clot-bound state, blocking thrombin generation. Predictable pharmacokinetics with twice-daily oral dosing and no routine lab monitoring. Used for stroke prevention in non-valvular atrial fibrillation and for VTE treatment and prevention.
Adverse effects
Life-threatening / NCLEX-tested
- Major bleeding — GI bleed is the most common serious event
- Intracranial hemorrhage (rate is lower than warfarin, but still significant)
- Spinal/epidural hematoma if given near neuraxial procedure
- Hypersensitivity reactions (rare)
Side effects
Common — what to teach
- Easy bruising
- Minor bleeding (gums, nosebleeds)
- Nausea
- Anemia from chronic occult bleeding
Food & drug interactions
Strong CYP3A4 + P-gp inhibitors (ketoconazole, ritonavir, clarithromycin) raise levels and bleeding risk — avoid the combination. Strong CYP3A4 + P-gp inducers (rifampin, carbamazepine, phenytoin, St. John's wort) lower levels and increase clotting risk — also avoid. NSAIDs, aspirin, clopidogrel, and SSRIs add bleeding risk. Unlike warfarin, no significant food-vitamin-K interaction.
Nursing implications
Assessment, monitoring, patient teaching
- Take with or without food, twice daily — adherence is critical because there is no INR safety net
- Reversal agent: andexanet alfa (Andexxa) for life-threatening bleeding; PCC may be used if andexanet unavailable
- Hold per protocol around invasive procedures (typically 24–48 h based on bleed risk and renal function)
- Renal dose adjustment for CrCl ≤ 30 mL/min and per age/weight criteria — verify dose before each refill
- Teach patients NOT to abruptly stop without bridging — risk of stroke or VTE recurrence is real
- Counsel to report black/tarry stools, blood in urine, severe headache, or unusual bruising
When to hold / contraindications
- Active major bleeding
- Severe renal impairment (re-evaluate; some indications contraindicate at CrCl < 15)
- Severe hepatic impairment (Child-Pugh C)
- Pre-procedure per institutional bleeding-risk protocol
- Co-administration of strong CYP3A4 + P-gp dual inhibitors or inducers
Memory anchor
DOACs end in "-xaban" (Xa inhibitors) or "-gatran" (direct thrombin). Apixaban = twice-daily, no INR, andexanet for bleeds. "Eliquis = Easy life, except don't miss doses."
Practice Apixaban questions
Test your recall on real NCLEX-style pharmacology questions — with full rationales and an AI Coach for the parts you miss.