Anticoagulation Management in Patients with Aneurysms

Mechanism of Action and Bleeding Risk

Apixaban is an orally administered direct factor Xa inhibitor that prevents blood clotting by inhibiting a key component of the coagulation cascade, with an approximate 12-hour half-life after oral administration and primarily metabolized via the liver, according to the National Comprehensive Cancer Network 1
The American College of Chest Physicians notes that apixaban has demonstrated a favorable bleeding profile compared to warfarin in clinical trials, but still carries an inherent risk of bleeding complications as an anticoagulant 2

The National Comprehensive Cancer Network recommends that apixaban should be avoided in patients with severe renal impairment (CrCl <15 mL/min) or significant hepatic impairment (transaminases >2 times upper limit of normal or total bilirubin >1.5 times upper limit of normal) 1
Apixaban should be discontinued at least 3 days before procedures with high bleeding risk if CrCl >30 mL/min, as suggested by clinical guidelines 4

For patients with known aneurysms requiring anticoagulation, the National Comprehensive Cancer Network guidelines suggest considering the indication for anticoagulation and thrombotic risk 3
The National Comprehensive Cancer Network notes that apixaban may be safer than other DOACs like edoxaban or rivaroxaban in patients with gastrointestinal or gastroesophageal lesions 3