From the Guidelines
Eliquis (apixaban) is a suitable option for patients with bioprosthetic valves and atrial fibrillation (afib), as it provides effective stroke prevention with a more straightforward dosing regimen compared to warfarin. The dosing for Eliquis in these patients is typically 5 mg twice daily, with a reduced dose of 2.5 mg twice daily for those meeting specific criteria such as age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 1. This recommendation is based on the findings from the ARISTOTLE trial, which included a small subgroup of patients with bioprosthetic valve implants and suggested that apixaban is an equitable alternative to warfarin in these patients 1.
Key considerations for the use of Eliquis in patients with bioprosthetic valves and afib include:
- Regular monitoring of kidney function, as dosage adjustments may be necessary if kidney function changes significantly 1
- Consistent dosing at approximately 12-hour intervals, with or without food
- Avoiding cessation of the medication without consulting a physician due to increased stroke risk
- Understanding that Eliquis works by inhibiting Factor Xa, preventing the formation of blood clots that could lead to stroke in patients with atrial fibrillation
It's essential to note that while Eliquis is suitable for patients with bioprosthetic valves, the evidence for its use in this population is based on small subgroups within larger trials, and further study is needed to fully understand its long-term efficacy and safety in this context 1. Nonetheless, Eliquis offers a valuable alternative to warfarin for stroke prevention in patients with bioprosthetic valves and afib, given its more straightforward dosing and reduced need for monitoring.
From the Research
Role of Eliquis (Apixaban) in Patients with Bioprosthetic Valves and Atrial Fibrillation
- The efficacy and safety of apixaban in patients with bioprosthetic valves and atrial fibrillation (AF) have been evaluated in several studies 2, 3, 4, 5.
- A retrospective single-center cohort study found that the use of novel oral anticoagulants (NOACs), including apixaban, in patients with bioprosthetic valves and AF appears to be safe and effective in preventing thromboembolic events, although it may increase the risk of bleeding 2.
- A multicenter clinical practice experience study found that the use of NOACs, including apixaban, in patients with AF and bioprosthetic valves or prior surgical valve repair is associated with a low risk of thromboembolic events and major bleeding 3.
- A subgroup analysis of the ARISTOTLE trial found that apixaban is effective and safe in patients with AF and a history of bioprosthetic valve replacement or native valve repair, with no significant differences in outcomes compared to warfarin 4.
- A study comparing the tolerability and effectiveness of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients with AF and bioprosthetic heart valves found that DOACs, including apixaban, are associated with a greater net clinical benefit due to lower rates of major bleeds and thromboembolic events 5.
Key Findings
- Apixaban is effective in preventing thromboembolic events in patients with bioprosthetic valves and AF 2, 3, 4.
- Apixaban is associated with a lower risk of major bleeding compared to VKAs in patients with bioprosthetic valves and AF 5.
- The efficacy and safety of apixaban are consistent across different patient populations, including those with normal, poor, or worsening renal function 6.