Management of Elderly Patients on Apixaban After Trauma

Initial Assessment and Management

• A patient over 65 years old on apixaban who experiences loss of consciousness and fall should undergo immediate assessment of neurological status and fall etiology, and a detailed history should be obtained focusing on location and cause of fall, difficulty with gait/balance, previous falls, time spent on ground, and whether loss of consciousness occurred, as recommended by the American College of Emergency Physicians 1
• The American Geriatrics Society suggests evaluating for orthostatic hypotension, carotid sinus hypersensitivity, and other cardiovascular causes of syncope, which are common in this age group 4
• Assess medication regimen for polypharmacy issues, particularly high-risk medications that may contribute to falls, as advised by the American College of Emergency Physicians and the Mayo Clinic 1, 5

Apixaban Management and Monitoring

• Full therapeutic anticoagulation should typically be resumed 24-72 hours after bleeding is controlled and surgical hemostasis (if any intervention was needed) is confirmed, according to the European Society of Cardiology 2, 3
• Consider referral to a multidisciplinary team including a pharmacist to review medications that may increase fall risk, as recommended by the American College of Emergency Physicians and the Mayo Clinic 1, 5