Can Eliquis (apixaban) 2.5mg be taken indefinitely?

Indefinite Use of Eliquis 2.5mg

Eliquis (apixaban) 2.5mg can be taken indefinitely in specific patient populations where long-term anticoagulation is indicated, particularly in patients with nonvalvular atrial fibrillation who meet dose reduction criteria.

Appropriate Indications for Long-term Apixaban 2.5mg Use

Atrial Fibrillation

• The 2.5mg twice daily dose is specifically indicated for patients with nonvalvular atrial fibrillation who meet at least 2 of the following criteria 1:

  • Age ≥80 years
  • Body weight ≤60 kg
  • Serum creatinine ≥1.5 mg/dL (or ≥133 μmol/L)

• The ARISTOTLE trial demonstrated that apixaban was superior to warfarin for stroke prevention in atrial fibrillation with lower rates of major bleeding and mortality 1

Extended VTE Prevention

• Apixaban 2.5mg twice daily is also approved for extended prevention of recurrent deep vein thrombosis (DVT) and pulmonary embolism (PE) after completing initial treatment 1
• The AMPLIFY-EXT trial evaluated apixaban (at doses of 2.5mg or 5mg twice daily) for extended prevention of recurrent VTE in patients who completed a 6-month course of anticoagulation 1

Safety Considerations for Indefinite Use

Renal Function

• Apixaban can be used in patients with moderate renal impairment (CrCl 30-50 mL/min) without dose adjustment unless other dose reduction criteria are met 1
• Should be avoided in patients with severe renal impairment (CrCl <15 mL/min) 1
• Patients with CrCl 15-30 mL/min should be monitored closely if apixaban is used 1

Hepatic Function

• Should be avoided in patients with hepatic impairment (transaminases >2 times the upper limit of normal or total bilirubin >1.5 times the upper limit of normal) 1

Drug Interactions

• Dose should be reduced to 2.5mg twice daily when combined with strong CYP3A4 and P-glycoprotein inhibitors (e.g., ketoconazole, itraconazole, ritonavir) in patients already receiving 5mg twice daily 1
• Patients already on the 2.5mg twice daily dose should avoid concomitant use of these inhibitors 1

Monitoring During Long-term Use

• No routine coagulation monitoring is required for patients on apixaban, which is an advantage for indefinite use 1, 2
• Regular assessment of renal function is recommended, particularly in elderly patients 2
• Monitor for signs of bleeding, including:
  • Unexpected bleeding or bruising
  • Red/pink/brown urine
  • Red or black stools
  • Coughing up blood
  • Vomiting blood 2

Important Warnings

• Abrupt discontinuation increases thrombotic risk - coverage with another anticoagulant may be needed if apixaban must be temporarily interrupted 1
• Currently no FDA-approved reversal agent for emergency situations, though andexanet alfa has been approved for reversal of apixaban-associated life-threatening bleeding 1
• Combining with antiplatelet agents significantly increases bleeding risk without providing additional protection against thromboembolism 2

Special Populations

• In cancer patients, apixaban 2.5mg twice daily may be considered for primary thromboprophylaxis for up to 6 months in high-risk ambulatory patients starting systemic anticancer treatment 1
• For orthopedic surgery patients, apixaban 2.5mg twice daily is recommended for VTE prophylaxis for 35 days after hip surgery or 14 days after knee surgery 2

In conclusion, for patients with appropriate indications such as nonvalvular atrial fibrillation meeting dose reduction criteria or extended VTE prevention, Eliquis 2.5mg can be safely taken indefinitely with proper monitoring and consideration of contraindications and drug interactions.