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ELIQUIS® (apixaban) is indicated for prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF), with one or more risk factors, such as prior stroke or transient ischaemic attack (TIA), age ≥75 years, hypertension, diabetes mellitus, symptomatic heart failure (NYHA Class ≥II); treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults; and, prevention of venous thromboembolic events (VTE) in patients who have undergone elective hip or knee replacement surgery.
If surgery or invasive procedures cannot be delayed1
ELIQUIS should be restarted after the invasive procedure or surgical intervention as soon as possible, provided the clinical situation allows and adequate haemostasis has been established1
Following surgery, other platelet aggregation inhibitors are not recommended concomitantly with ELIQUIS1
Catheter ablation (NVAF)1
ELIQUIS can be continued in patients undergoing catheter ablation (NVAF).
Spinal / epidural anaesthesia or puncture1
When neuraxial anaesthesia or spinal / epidural puncture is employed, patients treated with antithrombotic agents, such as ELIQUIS, are at risk of developing an epidural or spinal haematoma.1
Risk may be increased by:1
Patients are to be frequently monitored for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent diagnosis and treatment is necessary.1
Prior to neuraxial intervention, the physician should consider the potential benefit vs. the risk in anticoagulated patients or in patients to be anticoagulated for thromboprophylaxis.1
Guidance for use prior to cardioversion1
ELIQUIS can be continued in patients with NVAF requiring cardioversion, who are already on long-term anticoagulation with ELIQUIS. ELIQUIS can also be initiated prior to cardioversion in patients previously untreated with anticoagulants by following the guidelines below.1,2
AF = Atrial Fibrillation BD = Twice Daily CHA2DS2-VASc = Congestive heart failure, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65–74, Sex category (female) CrCl = Creatinine Clearance CT = Computed Tomography
NVAF = Non-Valvular Atrial Fibrillation TOE = Transoesophageal Echocardiography