A patient upset warfarin stopped and a new medication, apixaban, prescribed instead. What is the most appropriate advice you would give?

• A. Lower Bleeding Risk With Apixaban
• B. Higher Bleeding Risk With Apixaban
• C. No Difference In Bleeding Risk
• D. Apixaban Requires INR Monitoring

Answer: (A)

Switching from warfarin to apixaban changes the bleeding risk profile. Apixaban generally lowers the risk of major bleeding compared with warfarin, especially intracranial hemorrhage, because its effect is more predictable and less affected by diet or many drug interactions. That’s why the guidance is that bleeding risk is lower with apixaban. It also doesn’t require INR monitoring, which is a practical advantage over warfarin. However, bleeding can still occur, so monitor for signs of bleeding, adjust dosing for kidney function, and avoid NSAIDs or other drugs that heighten bleeding risk or interact with apixaban.