Non-valvular atrial fibrillation:

• Prophylaxis of stroke and systemic embolism when warfarin is not appropriate

Deep vein thrombosis (DVT) and pulmonary embolism (PE):

• Acute treatment of DVT and PE
• Prevention of recurrent DVT and PE

In patients undergoing Cardioversion and RF ablation requiring anticoagulant cover where continuing warfarin is not appropriate.

• Is the indication for prescribing apixaban approved by NHS Lothian?
• Does the patient weigh >50kg and <120kg?
• Does the benefit of anticoagulation outweigh the bleeding risk?
  • This must be discussed with the patient/guardian

• Does the patient have hepatic disease associated with coagulopathy?
  • Apixaban is contraindicated in such patients - check liver function.

• Does the patient have impaired renal function?
  • Apixaban may be contraindicated or require dose adjustments in such patients - check renal function.

• Is the patient prescribed concomitant interacting medicines?
  • Clarithromycin (may increase apixaban levels)
  • Other CYP3A4 inhibitors or inducers (see list on counselling page or BNF)

• Is the patient prescribed concomitant antiplatelets/anticoagulants/NSAIDs?
  • These usually need to be discontinued
  • Except after acute coronary syndrome (ACS)/percutaneous coronary intervention (PCI). This must be discussed with cardiology.

For patients with venous thrombosis Apixaban should be commenced 24 hours after last dose of dalteparin given.