From the Guidelines
Eliquis (apixaban) should be used with caution in patients with thrombocytopenia, as there is limited data on its safety in this population, and it may potentially worsen thrombocytopenia. According to the guidance from the SSC of the ISTH 1, data on the use of direct oral anticoagulants (DOACs), including apixaban, in patients with cancer-associated thrombosis and severe thrombocytopenia are lacking. The guidance recommends the use of low molecular weight heparin (LMWH) as the preferred anticoagulant in patients with thrombocytopenia, and suggests reducing the dose of LMWH or temporarily discontinuing anticoagulation in patients with severe thrombocytopenia.
While the exact mechanism of apixaban-induced thrombocytopenia is not well understood, it is thought to involve immune-mediated destruction of platelets. Patients taking Eliquis who develop or have pre-existing thrombocytopenia should be monitored closely, as the combination of reduced platelet count and anticoagulation can increase bleeding risk significantly.
Key considerations for managing patients with thrombocytopenia on Eliquis include:
- Regular complete blood count monitoring to detect any changes in platelet count
- Close monitoring for signs of bleeding or bruising
- Consideration of alternative anticoagulants or dose adjustment if thrombocytopenia worsens
- Platelet transfusion support may be necessary in patients with severe thrombocytopenia and a high risk of thrombus progression, as suggested by the guidance from the SSC of the ISTH 1.
Overall, the use of Eliquis in patients with thrombocytopenia requires careful consideration of the potential risks and benefits, and close monitoring to minimize the risk of adverse outcomes.
From the Research
Eliquis (Apixaban) and Thrombocytopenia
- The effect of Eliquis (apixaban) on thrombocytopenia is a topic of interest, with several studies investigating its use in patients with heparin-induced thrombocytopenia (HIT) 2, 3, 4.
- A study published in 2013 found that apixaban did not activate platelets in the presence of HIT antibodies, suggesting that it may be a safe alternative for anticoagulation in patients with HIT 2.
- Another study published in 2022 reported on the use of rivaroxaban and apixaban for the treatment of suspected or confirmed HIT, and found that no patients had new thrombosis during hospitalization after starting DOACs, including apixaban 3.
- A case report published in 2017 described a patient with serologically confirmed HIT who developed symptomatic bilateral lower limb deep vein thrombosis despite anticoagulation with argatroban, and was successfully switched to oral apixaban 4.
- However, a study published in 2024 found that apixaban was associated with a higher incidence of clinically relevant non-major bleeding, primarily grade 1 or 2 epistaxis, in pediatric patients with acute lymphoblastic leukemia or lymphoma 5.
- Thrombocytopenia was reported as a common adverse event in both the apixaban and standard of care groups in the 2024 study, with 28 patients in the apixaban group and 20 patients in the standard of care group experiencing thrombocytopenia or platelet count decreased 5.
Use of Apixaban in Patients with Thrombocytopenia
- The available evidence suggests that apixaban may be a safe and effective alternative for anticoagulation in patients with HIT, including those with thrombocytopenia 2, 3, 4.
- However, the use of apixaban in patients with thrombocytopenia should be carefully considered, taking into account the potential risks and benefits, including the risk of bleeding 5.
- Further studies are needed to fully understand the effects of apixaban on thrombocytopenia and to determine its safety and efficacy in this patient population 6.