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Bleeding risk: Apixaban increases the risk of bleeding and can cause serious, potentially fatal bleeding. Discontinue use of apixaban in patients with active pathological hemorrhage. Advise patients to be aware of the signs and symptoms of blood loss and instruct them to immediately report them or go to an emergency department.
Discontinuation: Premature discontinuation of any oral anticoagulant including apixaban, increases the risk of thrombotic events. If anticoagulation is discontinued for a reason other than pathological bleeding or completion of therapy, consider coverage with another anticoagulant.
Apixaban therapy should be temporarily interrupted prior to any elective surgery or other invasive procedure to reduce the risk of bleeding.
Apixaban is not recommended in patients with severe hepatic impairment.
Apixaban is not recommended in patients with renal impairment because there is limited clinical experience in patients with creatinine clearance ≤15 mL/min and no data in patients undergoing dialysis.
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