Suggestions for Peri-Procedural Management of Apixaban

CrCl T 1/2

Time of last dose of apixaban before procedure

(peri-procedural bridging is generally not required)

    Standard Risk of Bleeding

High Risk of Bleeding1

(major surgery, spinal puncture or placement of spinal/epidural catheter, and other situations in which complete hemostasis is required)

1 ASRA 4th edition 2018: hold 72 hours for all patients prior to neuraxial procedures, without consider of the effect of renal function on elimination half-life and clearance

> 80 ml/min           12 hrs                at least 24 hours at least 48 hours
50-79 ml/min 14.6 hrs
30-49 ml/min 17.6 hrs at least 48 hours at least 72 hours
15-29 ml/min 17.3 hrs
< 15 ml/min no data consider measuring drug activity with apixaban assay to determine absence of drug effect