[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Direct oral anticoagulants (DOACs)](https://durgical.com/en/pharmacology/classes/direct-oral-anticoagulants/) › Apixaban

[Pharmacology](https://durgical.com/en/pharmacology/) · [Direct oral anticoagulants (DOACs)](https://durgical.com/en/pharmacology/classes/direct-oral-anticoagulants/)

# Apixaban

An oral anticoagulant that blocks clotting factor Xa directly. Used in atrial fibrillation and venous thrombosis, with no routine INR checks.

Updated 2026-11-01

- Class: [Direct oral anticoagulants (DOACs)](https://durgical.com/en/pharmacology/classes/direct-oral-anticoagulants/)
- Enzyme: Coagulation factor Xa
- ATC code: B01AF02

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

✂**Coagulation factor Xa**Apixaban

ⓘ The figure shows human factor Xa with apixaban in its active site.

**Target in 3D:** Coagulation factor Xa. PDB structure 2P16 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/2P16) · Drag to rotate · pinch to zoom

## Mechanism of action

Apixaban binds the active site of factor Xa and blocks it, without needing antithrombin. It inhibits free factor Xa, factor Xa bound to clots and the prothrombinase complex, so less thrombin is made and less fibrin forms. It has no direct effect on platelets, but by lowering thrombin it reduces thrombin-driven platelet aggregation.

- Apixaban binds the active site of factor Xa
- Free and clot-bound Xa and prothrombinase are blocked
- Less thrombin is made, so less fibrin forms

## Pharmacokinetics

**Absorption**
By mouth, about half of the dose is absorbed; food does not change it. Peak levels come 3 to 4 hours after a dose.

**Distribution**
About 87% bound to plasma proteins.

**Metabolism**
In the liver, mainly by CYP3A4; it is also carried by P-glycoprotein.

**Elimination**
Through urine and faeces; the kidneys handle about a quarter of its clearance.

**Half-life**
About 12 hours; the effect lasts at least 24 hours after the last dose.

## Indications

- Prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. [Atrial fibrillation →](https://durgical.com/en/conditions/atrial-fibrillation/)
- Treatment of deep vein thrombosis and prevention of recurrence; prevention after hip or knee replacement. [Deep vein thrombosis →](https://durgical.com/en/conditions/deep-vein-thrombosis/)
- Treatment of pulmonary embolism and prevention of recurrence. [Pulmonary embolism →](https://durgical.com/en/conditions/pulmonary-embolism/)

## Adverse effects

### Common

- Bleeding: bruising, nosebleeds, gum bleeding
- Blood in the urine
- Nausea

### Serious (rare, important)

- Serious, sometimes fatal bleeding, including in the brain or gut
- Spinal or epidural haematoma with spinal anaesthesia or puncture, which can cause paralysis
- Clots and stroke if it is stopped early without another anticoagulant

## Contraindications

- Active pathological bleeding
- Severe hypersensitivity to apixaban
- Not recommended: prosthetic heart valves, triple-positive antiphospholipid syndrome, severe liver impairment, pregnancy

## Key interactions

**Combined strong CYP3A4 and P-glycoprotein inhibitors (ketoconazole, itraconazole, ritonavir)**
Raise apixaban levels and the risk of bleeding.

**Combined strong CYP3A4 and P-glycoprotein inducers (rifampicin, carbamazepine, phenytoin, St John's wort)**
Lower apixaban levels; to be avoided because protection against clots falls.

**Aspirin, other antiplatelets, NSAIDs, other anticoagulants, SSRIs and SNRIs**
Add to the risk of bleeding.

## What is monitored

- Signs of bleeding and haemoglobin when needed
- Kidney and liver function before starting and over time
- Neurological checks after spinal or epidural procedures

## Administration and safety

- Oral; for people who cannot swallow, the tablet may be crushed and given in water or through a nasogastric tube, as the label describes
- Missed doses and early stopping raise the risk of stroke; changes are planned with the treating team
- Timing around surgery, epidural catheters and spinal puncture follows a written plan
- Its anti-Xa effect can be reversed with andexanet alfa; dialysis removes little of it

## Nursing care

- Ask about bleeding history, kidney and liver disease and other drugs that affect clotting before the first dose
- Watch for bleeding: black stools, blood in urine, unusual bruising, severe headache
- After neuraxial anaesthesia, check legs for numbness or weakness, and back pain
- Teach the patient not to stop it on their own and to tell every dentist and surgeon

## Pregnancy and breastfeeding

Data in pregnancy are limited and it is not recommended; it can increase bleeding at delivery, especially with neuraxial anaesthesia.

## Memory aid

APIXaban: "-xaban" blocks Xa; twice a day, no INR, but CYP3A4 and P-gp decide its level.

## Test yourself

Think of the answer, then tap the question to see it.

## Which enzyme does apixaban block, and does it need antithrombin?

Factor Xa, directly: it binds the active site of free and clot-bound Xa without antithrombin.

## Which drug interaction raises apixaban levels the most?

Drugs that strongly inhibit both CYP3A4 and P-glycoprotein, such as ketoconazole, itraconazole or ritonavir.

## In which patients is apixaban not recommended even though they need an anticoagulant?

People with prosthetic heart valves and people with triple-positive antiphospholipid syndrome; warfarin is used there.

## Which agent reverses apixaban's anti-Xa effect?

Andexanet alfa, a modified factor Xa that binds it; protamine and vitamin K do not work.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/apixaban/)

## Related drugs

- [Rivaroxaban](https://durgical.com/en/pharmacology/rivaroxaban/)
- [Dabigatran](https://durgical.com/en/pharmacology/dabigatran/)
- [Warfarin](https://durgical.com/en/pharmacology/warfarin/)
- [Heparin](https://durgical.com/en/pharmacology/heparin/)

## Related conditions

- [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/)
- [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)

[← Back to the class: Direct oral anticoagulants (DOACs)](https://durgical.com/en/pharmacology/classes/direct-oral-anticoagulants/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - APIXABAN tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=19a60552-374d-4b8b-a8ce-ceae252ea5ba) (DailyMed (U.S. National Library of Medicine), 2026); [Apixaban: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a613032.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/?query=apixaban) (World Health Organization, 2025); [2P16: Factor Xa in Complex with the Inhibitor APIXABAN (BMS-562247)](https://www.rcsb.org/structure/2P16) (RCSB Protein Data Bank, 2007).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/pharmacology/apixaban/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/apixaban/