Can a patient with an increased risk for stroke be prescribed Eliquis (apixaban)?

From the Guidelines

Eliquis (apixaban) can be prescribed to patients with an increased risk for stroke, particularly those with atrial fibrillation, as it has been shown to be effective in reducing the risk of stroke and systemic embolism. The standard dosing is 5 mg twice daily for most patients, though a reduced dose of 2.5 mg twice daily is recommended for patients meeting at least two of these criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 1. Before starting Eliquis, it is essential to assess the patient's renal function, as severe renal impairment (CrCl <15 mL/min) is a contraindication. Additionally, evaluate for active bleeding, mechanical heart valves, or use of other anticoagulants, which would preclude Eliquis use. Patients should be counseled about bleeding risks, the importance of medication adherence (as missing doses increases stroke risk), and potential drug interactions, particularly with strong CYP3A4 and P-gp inhibitors or inducers.

Some key points to consider when prescribing Eliquis include:

• The ARISTOTLE trial demonstrated that apixaban was significantly better than warfarin in reducing the risk of stroke and systemic embolism, with fewer overall strokes, systemic emboli, and major bleeding events 1.
• The AVERROES trial showed that apixaban was superior to aspirin in preventing stroke or systemic embolism, with no significant difference in major bleeding 1.
• The combination of antiplatelet agents with anticoagulants, such as Eliquis, should be used with caution and only in selected patients with acute vascular disease, as it may increase the risk of bleeding events 1.
• Patients with severe or end-stage chronic kidney disease (CKD) were excluded from the ARISTOTLE and AVERROES trials, and therefore, the use of Eliquis in these patients should be approached with caution 1.

Overall, Eliquis (apixaban) is a viable option for patients with an increased risk of stroke, particularly those with atrial fibrillation, due to its efficacy in reducing the risk of stroke and systemic embolism, as well as its relatively favorable safety profile 1.

From the FDA Drug Label

Apixaban lowers your chance of having a stroke by helping to prevent clots from forming For people taking apixaban tablets for atrial fibrillation: People with atrial fibrillation (a type of irregular heartbeat) are at an increased risk of forming a blood clot in the heart, which can travel to the brain, causing a stroke, or to other parts of the body. Apixaban tablets are a prescription medicine used to: • reduce the risk of stroke and blood clots in people who have atrial fibrillation

Yes, a patient with an increased risk for stroke can be prescribed Eliquis (apixaban), as it is indicated to reduce the risk of stroke and blood clots in people with atrial fibrillation 2.

From the Research

Patient Eligibility for Eliquis (Apixaban)

• Patients with an increased risk for stroke can be prescribed Eliquis (apixaban) as it has been shown to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation 3.
• The efficacy and safety of apixaban have been demonstrated in patients with moderate chronic kidney disease, with a significant reduction in stroke risk compared to aspirin 4.
• Apixaban has also been shown to be cost-effective compared to warfarin in patients with atrial fibrillation, including those with chronic kidney disease 5.

Renal Function Considerations

• The efficacy of apixaban is not significantly affected by renal function, with benefits observed across all ranges of estimated glomerular filtration rate (eGFR) 6.
• Patients with impaired renal function may have a greater reduction in major bleeding events with apixaban compared to warfarin 6.
• Declining renal function over time is associated with a higher risk of cardiovascular events and bleeding, but the benefits of apixaban compared to warfarin are consistent in patients with normal, poor, and worsening renal function 7.

Treatment Outcomes

• Apixaban has been shown to reduce the risk of stroke or systemic embolism, major bleeding, and mortality compared to warfarin in patients with atrial fibrillation, regardless of renal function 3, 6, 7.
• The benefits of apixaban are consistent across different patient subgroups, including those with moderate chronic kidney disease and those with worsening renal function over time 4, 7.