What is the use of Apixaban (Eliquis)?

From the Guidelines

Apixaban is a highly effective oral anticoagulant for preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation, with a recommended dose of 5 mg twice daily, unless certain criteria are met that require a reduced dose of 2.5 mg twice daily. The use of apixaban has been extensively studied in various clinical trials, including the ARISTOTLE trial, which demonstrated its superiority over warfarin in preventing stroke or systemic embolization, with a lower risk of major bleeding 1. The standard dosing of apixaban is typically 5 mg twice daily, though a reduced dose of 2.5 mg twice daily is recommended for patients who meet at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.

Some key points to consider when prescribing apixaban include:

• Apixaban does not require routine blood monitoring, unlike warfarin, but does carry bleeding risks
• Patients should avoid other blood thinners unless specifically directed by their doctor
• Patients should inform all healthcare providers about taking this medication before procedures
• Apixaban works by directly inhibiting Factor Xa in the coagulation cascade, preventing the formation of thrombin and thus blood clots
• Certain medications like strong CYP3A4 inhibitors can affect its metabolism

Recent guidelines, such as the 2019 AHA/ACC/HRS focused update on atrial fibrillation, support the use of apixaban in patients with nonvalvular atrial fibrillation, including those with end-stage chronic kidney disease on dialysis 1. However, the use of apixaban in patients with mechanical heart valves is contraindicated due to the increased risk of thromboembolic and bleeding events. Overall, apixaban is a valuable treatment option for patients with nonvalvular atrial fibrillation, offering a favorable balance of efficacy and safety compared to traditional anticoagulants like warfarin.

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 a non-vitamin K oral anticoagulant approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF) 3, 4, 5.
• It is used as an alternative to warfarin, which has limitations such as frequent laboratory monitoring, drug interactions, and bleeding risks 3, 6.
• Apixaban has been shown to be effective in reducing the risk of stroke or systemic embolism in patients with AF, with a lower risk of major bleeding compared to warfarin 3, 7, 5.
• 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, 4.

Comparison with Other Anticoagulants

• Apixaban has been compared to warfarin in several studies, with results showing that apixaban is superior in preventing stroke or systemic embolism and causing less bleeding 3, 7, 5.
• Apixaban has also been compared to aspirin, with results showing that apixaban is more effective in reducing the risk of stroke or systemic embolism, but with a higher risk of major bleeding 6, 5.
• There is no clear advantage of apixaban over dabigatran, another oral anticoagulant, due to the lack of direct comparison studies and methodological flaws in existing studies 6.

Patient Factors and Dosing

• Patient factors such as age, weight, and renal function are important in determining the appropriate dose of apixaban 3, 4.
• Apixaban dosing is frequently inconsistent with labeling, with factors such as age, patient weight, and serum creatinine level associated with inappropriate dose reduction 4.
• Regular monitoring of renal function is necessary due to the increased anticoagulant action of apixaban in patients with renal failure 6.