From the Guidelines
Eliquis (apixaban) 5mg twice daily is the recommended prophylactic dosage for preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation, as supported by the ARISTOTLE trial 1. This dosage has been shown to be effective in reducing the risk of stroke and systemic embolism, while also minimizing the risk of major bleeding events.
- The ARISTOTLE trial demonstrated that apixaban 5mg twice daily was superior to warfarin in preventing stroke and systemic embolism, with a lower risk of major bleeding events 1.
- The AVERROES study also showed that apixaban 5mg twice daily was effective in preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation who were deemed unsuitable for warfarin therapy 1.
- Dose adjustments to 2.5mg twice daily may be necessary for patients with certain risk factors, including age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, as recommended by the 2014 AHA/ACC/HRS guideline 1.
- It is essential to note that patients with severe and end-stage chronic kidney disease (CKD) were excluded from the ARISTOTLE and AVERROES trials, and therefore, the safety and efficacy of apixaban in these patients have not been established 1.
- The 2012 American Heart Association/American Stroke Association science advisory also supports the use of apixaban 5mg twice daily as an alternative to aspirin in patients with nonvalvular atrial fibrillation deemed unsuitable for vitamin K antagonist therapy 1.
From the FDA Drug Label
1.2 Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery Apixaban tablets are indicated for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery.
2.1 Recommended Dose Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily.
The dose of Eliquis (apixaban) for prophylaxis is 2.5 mg twice a day, not 5mg twice a day, for patients who have undergone hip or knee replacement surgery 2.
From the Research
Eliquis 5mg Twice a Day Given Prophylactically
- The dosage of Eliquis (apixaban) 5mg twice a day is a common regimen for prophylactic use in patients with non-valvular atrial fibrillation [ 3, 4, 5, 6, 7 ].
- Studies have shown that apixaban is effective in preventing stroke and systemic embolism, with a lower risk of major bleeding compared to other non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran and rivaroxaban [ 3, 4, 5, 6, 7 ].
- A network meta-analysis found that apixaban had a favorable efficacy and safety profile compared to other NOACs, including dabigatran, rivaroxaban, and edoxaban [ 6 ].
- A nationwide pharmacoepidemiological study found that apixaban was similarly effective as warfarin in preventing ischemic stroke, transient ischemic attack, or systemic embolism, with a lower risk of major bleeding [ 7 ].
Comparison with Other Anticoagulants
- Apixaban has been compared to warfarin, dabigatran, and rivaroxaban in several studies, with results showing that apixaban has a lower risk of major bleeding and similar efficacy in preventing stroke and systemic embolism [ 3, 4, 5, 6, 7 ].
- A study found that apixaban had a significantly lower risk of major bleeding compared to rivaroxaban, with a hazard ratio of 0.53 (95% CI 0.39-0.71) [ 5 ].
- Another study found that apixaban had a lower risk of intracranial bleeding compared to warfarin, dabigatran, and rivaroxaban [ 7 ].
Safety and Efficacy
- The safety and efficacy of apixaban have been established in several studies, with results showing that apixaban is effective in preventing stroke and systemic embolism, with a lower risk of major bleeding [ 3, 4, 5, 6, 7 ].
- A study found that apixaban had a favorable safety profile, with a lower risk of major bleeding and intracranial bleeding compared to other NOACs [ 6 ].
- Another study found that apixaban had a similar efficacy and safety profile compared to warfarin, with a lower risk of major bleeding [ 7 ].