From the Guidelines
Eliquis (apixaban) is contraindicated in patients with pregnancy or breastfeeding, stage IV/V chronic kidney disease (CrCl <30 mL/min), and active/clinically significant liver disease (Child-Pugh Class B or C or alanine aminotransferase (ALT)/aspartate aminotransferase (AST) >3x upper limit of normal (ULN); total bilirubin >2x ULN). The contraindications for Eliquis (apixaban) are outlined in the NCCN clinical practice guidelines in oncology, version 2.2024 1. Key points to consider include:
- Contraindications: pregnancy or breastfeeding, stage IV/V chronic kidney disease (CrCl <30 mL/min), and active/clinically significant liver disease
- Relative contraindications: use with caution in patients with compromised renal or liver function, genitourinary or GI tract lesions, pathology, or instrumentation, and those receiving nephrotoxic or hepatotoxic chemotherapy
- Important drug interactions: strong dual inhibitors/inducers of CYP3A4 and P-gp, which can significantly increase apixaban levels 1. It is essential to carefully evaluate the patient's medical history, current medications, and potential drug interactions before initiating apixaban therapy to minimize the risk of adverse events.
From the FDA Drug Label
4 CONTRAINDICATIONS
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)]
The contraindications for Eliquis (apixaban) are:
- Active pathological bleeding
- Severe hypersensitivity reaction to apixaban, such as anaphylactic reactions 2
From the Research
Contraindications for Eliquis (Apixaban)
The following are contraindications for Eliquis (apixaban) based on available evidence:
- Active pathological bleeding 3
- Severe hepatic impairment 3
- Hepatic disease associated with coagulopathy and clinically relevant bleeding risk 3
- Patients with mechanical prosthetic heart valves 4
- Clinically significant mitral stenosis 4
Special Considerations
Some special considerations for the use of apixaban include:
- 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
- Not recommended in patients with elevated liver enzymes (>2× ULN) 3
- Patients >75 years old, or those with cancer, low or high body weight, or poor renal function require careful consideration due to limited data on apixaban use in these populations 5
- Pediatric patients and patients with a history of heparin-induced thrombocytopenia or identified forms of thrombophilia also require careful consideration due to limited data on apixaban use in these populations 5