If traumatic puncture occurs, delay the administration of ELIQUIS for 48 hours. The risk may also be increased by traumatic or repeated epidural or spinal puncture. The next dose of ELIQUIS should not be administered earlier than 5 hours after the removal of the catheter. Indwelling epidural or intrathecal catheters should not be removed earlier than 24 hours after the last administration of ELIQUIS. The risk of these events may be increased by the postoperative use of indwelling epidural catheters or the concomitant use of medicinal products affecting hemostasis. Spinal/Epidural Anesthesia or Puncture: Patients treated with ELIQUIS undergoing spinal/epidural anesthesia or puncture may develop an epidural or spinal hematoma which can result in long-term or permanent paralysis.Please visit for more information on availability of a reversal agent. An agent to reverse the anti-factor Xa activity of apixaban is available. The anticoagulant effect of apixaban can be expected to persist for at least 24 hours after the last dose (i.e., about two half-lives).Discontinue ELIQUIS in patients with active pathological hemorrhage. Advise patients of signs and symptoms of blood loss and to report them immediately or go to an emergency room.Concomitant use of drugs affecting hemostasis increases the risk of bleeding, including aspirin and other antiplatelet agents, other anticoagulants, heparin, thrombolytic agents, SSRIs, SNRIs, and NSAIDs.Bleeding Risk: ELIQUIS increases the risk of bleeding and can cause serious, potentially fatal, bleeding.If ELIQUIS is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant. An increased rate of stroke was observed during the transition from ELIQUIS to warfarin in clinical trials in atrial fibrillation patients. Increased Risk of Thrombotic Events after Premature Discontinuation: Premature discontinuation of any oral anticoagulant, including ELIQUIS, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events.Severe hypersensitivity reaction to ELIQUIS (e.g., anaphylactic reactions).If neurological compromise is noted, urgent treatment is necessary.Ĭonsider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated. Monitor patients frequently for signs and symptoms of neurological impairment. optimal timing between the administration of ELIQUIS and neuraxial procedures is not known.a history of spinal deformity or spinal surgery.a history of traumatic or repeated epidural or spinal punctures.concomitant use of other drugs that affect hemostasis, such as nonsteroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants.Factors that can increase the risk of developing epidural or spinal hematomas in these patients include: Consider these risks when scheduling patients for spinal procedures. These hematomas may result in long-term or permanent paralysis. (B) Epidural or spinal hematomas may occur in patients treated with ELIQUIS who are receiving neuraxial anesthesia or undergoing spinal puncture. If anticoagulation with ELIQUIS is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant. (A) Premature discontinuation of any oral anticoagulant, including ELIQUIS ® (apixaban), increases the risk of thrombotic events. WARNING: (A) PREMATURE DISCONTINUATION OF ELIQUIS INCREASES THE RISK OF THROMBOTIC EVENTS, (B) SPINAL/EPIDURAL HEMATOMA SELECTED IMPORTANT SAFETY INFORMATION IMPORTANT SAFETY INFORMATION MORE IMPORTANT SAFETY INFORMATION

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