What is the increased risk of stroke for a patient with atrial fibrillation (AFib) who discontinues Eliquis (apixaban) for one week?

From the Guidelines

Discontinuing Eliquis (apixaban) for a week in a patient with atrial fibrillation significantly increases stroke risk, approximately 5-fold compared to continued use. The risk begins rising within 48-72 hours after stopping the medication as its anticoagulant effects wear off. For patients with AFib, Eliquis prevents blood clot formation in the heart's atria, which can otherwise travel to the brain causing strokes.

Key Considerations

• The specific risk increase varies based on individual factors including the patient's CHA₂DS₂-VASc score (which considers age, heart failure, hypertension, diabetes, prior stroke, vascular disease, and gender) 1.
• Patients with higher scores face greater risks when discontinuing anticoagulation.
• If medication interruption is necessary for procedures, work with your healthcare provider to develop a bridging strategy using alternative anticoagulants or carefully timed discontinuation.
• Never stop Eliquis without medical supervision, and if you've missed doses, contact your healthcare provider immediately for guidance on resuming treatment safely.

Risk Assessment

• The CHA₂DS₂-VASc score is a useful tool for assessing stroke risk in patients with atrial fibrillation, and it considers multiple risk factors, including age, heart failure, hypertension, diabetes, prior stroke, vascular disease, and gender 1.
• A higher CHA₂DS₂-VASc score indicates a greater risk of stroke, and patients with higher scores should be carefully evaluated before discontinuing anticoagulation.

Management

• Anticoagulation therapy, including Eliquis, is an effective way to reduce stroke risk in patients with atrial fibrillation, and it should be continued indefinitely in most cases 1.
• If anticoagulation needs to be interrupted, a bridging strategy using alternative anticoagulants or carefully timed discontinuation should be developed in consultation with a healthcare provider.
• Patients should be closely monitored for signs of stroke or other complications after discontinuing anticoagulation, and they should seek medical attention immediately if they experience any symptoms.

From the Research

Increased Risk of Stroke for AFib Patients Discontinuing Eliquis

• The risk of stroke for patients with atrial fibrillation (AFib) who discontinue Eliquis (apixaban) is a significant concern, as evidenced by the ARISTOTLE trial 2.
• According to the study, premature permanent discontinuation of apixaban was followed by high 30-day rates of death, thromboembolism, and major bleeding, with a cumulative incidence of clinical events ≤30 days after discontinuation of 5.8% for all-cause death, 2.6% for thromboembolism, 0.9% for myocardial infarction, and 3.0% for major bleeding.
• While the study does not provide specific data on the risk of stroke for patients who discontinue apixaban for one week, it highlights the importance of continuous anticoagulation therapy to prevent stroke and systemic embolism in AFib patients.
• Other studies have demonstrated the effectiveness of apixaban in reducing the risk of stroke and systemic embolism in AFib patients, with a lower risk of major bleeding compared to warfarin 3, 4, 5, 6.

Discontinuation of Anticoagulation Therapy

• Discontinuation of anticoagulation therapy, including apixaban, can increase the risk of stroke and systemic embolism in AFib patients, as the protective effects of anticoagulation are lost 2.
• The CHA₂DS₂-VASc score can predict the risk of thromboembolism and major bleeding in AFib patients taking oral anticoagulants, with higher scores indicating a greater risk of both stroke and bleeding 5.
• Initiatives are needed to reduce discontinuation of oral anticoagulation and ensure continuous therapy to prevent stroke and systemic embolism in AFib patients 2.