From the Guidelines
Eliquis (apixaban) is contraindicated in patients with pregnancy or breastfeeding, stage IV/V chronic kidney disease (CrCl <30 mL/min), active/clinically significant liver disease, and those taking strong dual inhibitors/inducers of CYP3A4 and P-gp. According to the most recent guidelines, patients with these conditions should avoid Eliquis due to increased risk of bleeding or other adverse effects 1. The guidelines also recommend using Eliquis with caution in patients with compromised renal or liver function, genitourinary or GI tract lesions, pathology, or instrumentation, as well as those receiving nephrotoxic or hepatotoxic chemotherapy 1.
Key contraindications for Eliquis include:
- Pregnancy or breastfeeding
- Stage IV/V chronic kidney disease (CrCl <30 mL/min)
- Active/clinically significant liver disease
- Strong dual inhibitors/inducers of CYP3A4 and P-gp Relative contraindications and precautions include:
- Compromised renal or liver function
- Genitourinary or GI tract lesions, pathology, or instrumentation
- Nephrotoxic or hepatotoxic chemotherapy
- Concurrent use with other medications that may increase the risk of bleeding
It is essential to carefully evaluate the patient's medical history, current medications, and laboratory results before initiating Eliquis therapy, and to monitor them closely for potential adverse effects 1. The most recent study from 2024 provides the strongest evidence for these contraindications and precautions, and should be prioritized in clinical decision-making 1.
From the FDA Drug Label
Apixaban tablets are contraindicated in patients with the following conditions: • Active pathological bleeding [see Warnings and Precautions (5.2) and Adverse Reactions(6.1)] • Severe hypersensitivity reaction to apixaban (e.g., anaphylactic reactions) [see Adverse Reactions (6.1)]
CONTRAINDICATIONS Active pathological bleeding (4) Severe hypersensitivity to apixaban (4)
The contraindications for Eliquis (apixaban) are:
- Active pathological bleeding
- Severe hypersensitivity to apixaban (e.g., anaphylactic reactions) 2, 2, 2
From the Research
Contraindications for Eliquis (Apixaban)
- The following are contraindications for Eliquis:
- Note that apixaban can be used with caution in patients with mild (Child-Pugh A) or moderate (Child-Pugh B) hepatic impairment or in patients with alanine aminotransferase and aspartate aminotransferase levels >2× upper limit of normal (ULN) 3
- There is no clear contraindication for apixaban in patients with severe renal impairment, and some studies suggest it may be safe and effective in this population 4, 5
- However, it is essential to monitor patients with renal impairment for signs of bleeding throughout the duration of therapy 4