What is the use of Apixaban (Eliquis)?

From the Guidelines

Apixaban is a highly effective oral anticoagulant for preventing stroke in patients with nonvalvular atrial fibrillation, and its use is recommended over aspirin and warfarin due to its superior efficacy and safety profile, as demonstrated in the ARISTOTLE trial 1. The standard dosing of apixaban is 5 mg twice daily, unless the patient meets at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, in which case a reduced dose of 2.5 mg twice daily is recommended 1. Some key benefits of apixaban include:

• Reduced risk of stroke or systemic embolism compared to warfarin (1.27% vs 1.60%, HR 0.79,95% CI 0.66-0.95) 1
• Lower risk of major bleeding compared to warfarin (2.13% vs 3.09%, HR 0.69,95% CI 0.60-0.80) 1
• No requirement for routine blood monitoring, unlike warfarin 1
• Fewer food and drug interactions compared to warfarin 1 However, apixaban should be used cautiously in patients with severe renal impairment, and patients should be aware of the risk of bleeding, with common side effects including bruising and minor bleeding 1. It is essential for patients to not stop taking apixaban suddenly without medical supervision, as this could increase stroke risk, and they should inform all healthcare providers about taking this medication before any procedures 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.

The use of Apixaban (Eliquis) is to:

• Reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
• Prevent deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery
• Treat DVT and PE, and reduce the risk of recurrent DVT and PE following initial therapy 2 Key points about the use of Apixaban include:
• It is used to prevent stroke and blood clots in people with atrial fibrillation
• It is used to prevent blood clots in the legs and lungs of people who have had hip or knee replacement surgery
• It is used to treat blood clots in the veins of the legs or lungs, and to reduce the risk of them occurring again 2 2

From the Research

Use of Apixaban (Eliquis)

• Apixaban is used for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation 3, 4, 5, 6.
• It is a direct factor Xa inhibitor with predictable pharmacodynamics and pharmacokinetics, and does not require routine anticoagulation monitoring 5.
• Apixaban has been shown to be superior to warfarin in reducing stroke or systemic embolism, all-cause mortality, and major bleeding in patients with atrial fibrillation 3, 5, 6.
• It is also more effective than aspirin for stroke prevention in patients with atrial fibrillation who are considered unsuitable for warfarin therapy, with a similar rate of major bleeding 4, 6.

Patient Populations

• Apixaban is effective in patients with nonvalvular atrial fibrillation and at least one additional risk factor for stroke 3, 5, 6.
• It is also effective in patients with stage III chronic kidney disease, with a significant reduction in stroke or systemic embolism compared to aspirin 4.
• Apixaban can be used in patients who are unable to achieve therapeutic goals with warfarin therapy 3.

Dosage and Administration

• The normal dosage of apixaban is 5 mg orally twice daily, but it may be reduced to 2.5 mg twice daily based on individual factors such as age, renal function, and body weight 3.
• Apixaban has a half-life of about 12 hours 3.

Safety and Efficacy

• Apixaban has been shown to have a lower risk of major bleeding compared to warfarin, and a similar rate of major bleeding compared to aspirin 3, 4, 5, 6.
• It has also been shown to have a lower risk of intracranial hemorrhage compared to warfarin 5.