What is Apixaban (Eliquis) used for?

From the Guidelines

Apixaban (Eliquis) is used for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, and it has been shown to be superior to warfarin in reducing the risk of stroke and systemic embolism, with a similar rate of major bleeding 1.

Key Indications

• Prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
• Secondary prevention of stroke or systemic embolism in patients with a history of stroke or transient ischemic attack (TIA)

Dosage and Administration

• The recommended dose of apixaban is 5 mg twice daily, unless the patient meets certain criteria for a lower dose of 2.5 mg twice daily, such as age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 1

Clinical Evidence

• The ARISTOTLE trial demonstrated that apixaban was superior to warfarin in reducing the risk of stroke and systemic embolism, with a similar rate of major bleeding 1
• The AVERROES study showed that apixaban was superior to aspirin in preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation who were deemed unsuitable for warfarin therapy 1

Patient Selection

• Patients with nonvalvular atrial fibrillation and at least one additional risk factor for stroke, such as age ≥75 years, prior stroke or TIA, symptomatic heart failure, diabetes mellitus, or hypertension that requires pharmacological treatment 1
• Patients who have previously taken a vitamin K antagonist, such as warfarin, and are transitioning to apixaban 1

Important Considerations

• Apixaban has been shown to be effective in reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, but it is not recommended for patients with severe or end-stage chronic kidney disease (CKD) who are not on dialysis, as there are limited data on its use in these patients 1

From the FDA Drug Label

Apixaban is a factor Xa inhibitor indicated: to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. (1.1) for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery. (1.2) for the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following initial therapy. (1.3,1.4,1.5) Apixaban tablets are a prescription medicine used to: • reduce the risk of stroke and blood clots in people who have atrial fibrillation • reduce the risk of forming a blood clot in the legs and lungs of people who have just had hip or knee replacement surgery. • treat blood clots in the veins of your legs (deep vein thrombosis) or lungs (pulmonary embolism), and reduce the risk of them occurring again.

Apixaban (Eliquis) is used for:

• Reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
• Prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery
• Treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following initial therapy 2 Key points:
• Apixaban is a factor Xa inhibitor
• It is used to reduce the risk of stroke and blood clots in people with atrial fibrillation
• It is also used to reduce the risk of forming a blood clot in the legs and lungs of people who have just had hip or knee replacement surgery
• It is used to treat blood clots in the veins of the legs or lungs, and reduce the risk of them occurring again 2, 2

From the Research

Uses of Apixaban (Eliquis)

• Apixaban is used for stroke prevention in people with subclinical atrial fibrillation and a history of stroke or transient ischaemic attack 3
• It is also used for the prevention of stroke and systemic embolism in patients with atrial fibrillation 4
• Apixaban is approved for venous thromboembolism (VTE) prophylaxis in total hip replacement and total knee replacement 4
• It is used for the treatment and secondary prevention of venous thromboembolism (VTE) 5
• Apixaban can be considered for secondary stroke prevention in people with subclinical atrial fibrillation and a history of stroke or transient ischaemic attack 3

Benefits and Risks

• Apixaban has been shown to reduce the risk of stroke or systemic embolism compared to aspirin in people with subclinical atrial fibrillation 3
• It has a predictable pharmacokinetic profile and a low risk of major bleeding compared to warfarin 4, 6
• Apixaban has a relatively wide therapeutic window and a low number of drug and food interactions 7
• However, it can increase the risk of major bleeding, particularly in patients with a history of stroke or transient ischaemic attack 3