What is the incidence of Eliquis (apixaban) failing to prevent atrial fibrillation (AFib)-related strokes in patients on the correct dosing and 100% compliant?

From the Guidelines

The incidence of Eliquis (apixaban) failing to prevent atrial fibrillation-related strokes in fully compliant patients on correct dosing is approximately 1.27% per year, as demonstrated in the ARISTOTLE trial 1. This means that even with perfect adherence to the medication regimen, a small percentage of patients will still experience stroke events. Apixaban is highly effective but not 100% protective against AFib-related strokes. The standard dosing for most patients is 5 mg twice daily, though some patients (those ≥80 years, ≤60 kg, or with serum creatinine ≥1.5 mg/dL) should receive 2.5 mg twice daily. This failure rate represents a significant improvement over no anticoagulation, where stroke risk might be 5% or higher annually depending on individual risk factors. Key points to consider include:

• The medication works by inhibiting Factor Xa in the coagulation cascade, preventing thrombus formation in the left atrial appendage where most AFib-related clots originate.
• Patients should understand that while breakthrough strokes can occur despite proper treatment, maintaining consistent medication timing and never skipping doses maximizes protection.
• Regular monitoring by healthcare providers remains important even with good medication compliance, as the ARISTOTLE trial showed consistent treatment effects across prespecified subgroups, including those based on concurrent aspirin use at randomization, warfarin use before study enrollment, type of AF (paroxysmal versus permanent), and prior stroke or TIA status 1. The benefits of apixaban over warfarin, including a reduction in hemorrhagic stroke and major bleeding, further support its use in preventing AFib-related strokes in compliant patients on correct dosing 1.

From the Research

Incidence of Eliquis Failing to Prevent AFib-Related Strokes

• The incidence of Eliquis (apixaban) failing to prevent atrial fibrillation (AFib)-related strokes in patients on the correct dosing and 100% compliant is not directly stated in the provided studies.
• However, studies have compared the effectiveness of apixaban with other anticoagulants in preventing stroke in patients with non-valvular atrial fibrillation (NVAF) 2, 3, 4, 5, 6.
• A study published in 2019 found that apixaban was similarly effective as warfarin in preventing ischemic stroke, transient ischemic attack (TIA), or systemic embolism in patients with NVAF, with an adjusted hazard ratio (HR) of 0.97 (95% CI 0.75-1.26) 3.
• Another study published in 2020 found that apixaban was less effective in patients with a history of stroke or TIA, with a hazard ratio (HR) of 0.97 (95% CI 0.75-1.26) compared to warfarin, while dabigatran and rivaroxaban were more effective in this subgroup 4.
• A study published in 2017 found that apixaban was associated with a lower risk of stroke or systemic embolism (HR 0.67,95% CI 0.46-0.98) and major bleeding (HR 0.45,95% CI 0.34-0.59) compared to warfarin in patients with NVAF 5.
• Overall, while the exact incidence of Eliquis failing to prevent AFib-related strokes is not provided, the studies suggest that apixaban is generally effective in preventing stroke in patients with NVAF, but its effectiveness may vary depending on the patient population and comparison with other anticoagulants 2, 3, 4, 5, 6.

Comparison with Other Anticoagulants

• Apixaban has been compared with other anticoagulants, including warfarin, dabigatran, and rivaroxaban, in terms of its effectiveness and safety in preventing stroke in patients with NVAF 3, 4, 5, 6.
• The studies suggest that apixaban has a favorable effectiveness and safety profile compared to warfarin, with a lower risk of stroke and major bleeding 5, 6.
• However, the comparison with other direct oral anticoagulants (DOACs) such as dabigatran and rivaroxaban is less clear, with some studies suggesting that apixaban may be less effective in certain patient subgroups 4.

Patient Compliance and Dosing Regimen

• The studies do not provide direct information on the incidence of Eliquis failing to prevent AFib-related strokes in patients on the correct dosing and 100% compliant.
• However, a study published in 2017 discussed the importance of dosing regimen and patient compliance in maintaining optimum anticoagulation, with once-daily dosing regimens potentially leading to better adherence and persistence to therapy 2.