From the Guidelines
Eliquis (apixaban) should be started within 24-48 hours after a TIA, once intracranial hemorrhage has been ruled out by imaging, to reduce the risk of recurrent stroke and improve quality of life. The standard dosing is 5 mg twice daily for most patients, though 2.5 mg twice daily is recommended for patients meeting at least two of these criteria: age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, as suggested by 1.
Key Considerations
- Before starting Eliquis, patients should have a complete workup to determine the TIA etiology, and any contraindications such as active bleeding, severe renal impairment (CrCl <15 mL/min), or drug interactions should be assessed 1.
- Eliquis works by inhibiting Factor Xa in the coagulation cascade, preventing thrombin formation and clot development, making it effective for preventing recurrent strokes in patients who have experienced a TIA.
- Regular monitoring of renal function and bleeding risk is important during treatment, though routine coagulation monitoring is not required, as recommended by 1.
- Medication adherence should be continually assessed and reinforced for patients on all oral anticoagulants at each follow-up visit, and patients who are prescribed a DOAC should be reassessed at intervals and educated regarding the short half-life of this class of drugs, the importance of daily medication adherence and the dangers of missed doses or prolonged interruptions of therapy 1.
Monitoring and Adjustments
- Creatinine clearance should be routinely monitored at least once annually, and when there is a change in health status, and dose adjustments or a change in selected agent may be required based on changes in renal function if detected 1.
- More frequent monitoring of renal function (every 6 months or more frequently) may be considered for patients with moderate or severe renal impairment or a dehydrating illness for medication adjustment if required 1.
From the Research
Use of Eliquis after a TIA
- The decision to use Eliquis (apixaban) after a transient ischemic attack (TIA) should be based on the patient's individual risk factors and medical history 2, 3, 4, 5, 6.
- Studies have shown that apixaban is effective in reducing the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation, including those with a history of TIA 2, 4, 5, 6.
- A study published in 2020 found that apixaban was less effective in patients with a history of stroke or TIA compared to dabigatran and rivaroxaban 2.
- However, another study published in 2021 found that apixaban had a lower rate of stroke and psychiatric illness compared to acenocumarol in patients with non-valvular atrial fibrillation 3.
- The choice of anticoagulant therapy should be made after careful consideration of the benefit-to-risk ratio, taking into account the patient's individual risk factors and medical history 3, 4, 6.
- Apixaban has been shown to be safe and effective in patients with atrial fibrillation, including those with a history of TIA, and may be a suitable option for stroke prevention in these patients 4, 5, 6.