From the FDA Drug Label
Anemia (including postoperative and hemorrhagic anemia, and respective laboratory parameters) 153 (2.6) 178 (3.0) Hgb decrease ≥2 g/dL 13 (0.49%) 10 (0.38%) 8 (0.53%) 9 (0.60%) 10 (0.63%) 16 (1.01%) Transfusion of ≥2 units RBC 16 (0.60%) 14 (0.53%) 5 (0.33%) 9 (0.60%) 9 (0.56%) 18 (1.13%)
Eliquis (apixaban) may worsen anemia due to its bleeding risks, as evidenced by the reported cases of anemia, hemoglobin decrease, and transfusions in the clinical trials 1.
- Bleeding risks: Eliquis increases the risk of bleeding, which can lead to anemia.
- Anemia cases: Anemia was reported in 2.6% of apixaban-treated patients, and hemoglobin decrease ≥2 g/dL was reported in 0.49% to 1.01% of patients.
- Transfusions: Transfusions of ≥2 units RBC were reported in 0.60% to 1.13% of patients.
From the Research
Eliquis (apixaban) can potentially worsen anemia due to its anticoagulant properties, which increase the risk of bleeding and subsequently reduce the body's red blood cell count. The most recent and highest quality study, published in 2022 2, investigated the impact of anemia on clinical outcomes in elderly patients with atrial fibrillation receiving apixaban. This study found that moderate-severe anemia was an independent risk factor for total death, but not for strokes or systemic embolisms and bleeding requiring hospitalization. Key points to consider:
- Apixaban works by inhibiting blood clotting, which can increase the risk of bleeding, manifesting as obvious or occult bleeding that can lead to or worsen existing anemia.
- Patients taking Eliquis who have anemia or develop symptoms of anemia should contact their healthcare provider promptly.
- Regular monitoring of complete blood counts while on Eliquis can help detect anemia early, and any unexplained decrease in hemoglobin or hematocrit levels should be investigated for potential bleeding sources.
- The typical dose of Eliquis is 5 mg twice daily for most patients with atrial fibrillation, though some patients may receive 2.5 mg twice daily based on age, weight, or kidney function. Other studies, such as the ARISTOTLE trial 3, have also shown that apixaban is associated with a lower rate of intracranial hemorrhages and less adverse consequences following extracranial hemorrhage compared to warfarin. However, the 2022 study 2 provides the most recent and relevant evidence for the specific question of whether Eliquis can worsen anemia.