From the Guidelines
Yes, apixaban (Eliquis) is used long-term for atrial fibrillation (AFib) to reduce the risk of stroke and systemic embolism.
Key Points
- The ARISTOTLE trial 1 demonstrated that apixaban was superior to warfarin in reducing stroke or systemic embolism (1.27% vs 1.60%) and major bleeding (2.13% vs 3.09%) in patients with AFib.
- The 2014 AHA/ACC/HRS guideline 1 recommends apixaban as an alternative to warfarin for stroke prevention in patients with nonvalvular AFib, with a dose of 5 mg twice daily.
- The 2014 AHA/ACC/HRS guideline 1 also notes that apixaban can be used in patients with end-stage renal disease on hemodialysis, with a recommended dose of 5 mg twice daily, reduced to 2.5 mg twice daily for patients aged ≥80 years or weighing ≤60 kg.
- The 2021 guideline for the prevention of stroke 1 recommends apixaban, dabigatran, edoxaban, or rivaroxaban over warfarin for patients with AFib and stroke or transient ischemic attack, due to their improved safety profile and reduced risk of hemorrhagic stroke.
Dosage and Administration
- The recommended dose of apixaban for stroke prevention in AFib is 5 mg twice daily, with a reduced dose of 2.5 mg twice daily for patients with certain characteristics, such as age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 1.
- Apixaban should be taken orally, with or without food, and at the same time every day to maintain consistent drug levels.
Important Considerations
- Apixaban is contraindicated in patients with severe renal impairment (creatinine clearance <15 mL/min) and in those with active bleeding or a history of bleeding disorders 1.
- Patients with end-stage renal disease on hemodialysis should have their apixaban dose adjusted to 5 mg twice daily, with a reduction to 2.5 mg twice daily for patients aged ≥80 years or weighing ≤60 kg 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. The answer is yes, apixaban (Eliquis) is used long-term for atrial fibrillation (AFib), specifically to reduce the risk of stroke and systemic embolism in patients with nonvalvular AFib 2.
From the Research
Apixaban Use in Atrial Fibrillation
- Apixaban is used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AFib) 3, 4, 5, 6, 7.
- The efficacy and safety of apixaban compared to warfarin have been evaluated in several studies, including the ARISTOTLE trial 5, 6.
- Apixaban has been shown to be effective in reducing the risk of stroke and systemic embolism in patients with AFib, with a lower risk of major bleeding compared to warfarin 3, 4, 5, 6, 7.
Long-Term Use of Apixaban
- The long-term health benefits of apixaban compared to warfarin have been evaluated in a population-based modelling study in Germany 7.
- The study found that the use of apixaban instead of warfarin could avoid a significant number of major clinical events, including non-fatal strokes, non-fatal major bleeds, and all-cause deaths, resulting in a considerable reduction in cardiovascular events 7.
- Apixaban has been shown to be safe and effective for long-term use in patients with AFib, with a low incidence of thromboembolic events and major bleeding 3, 5.
Clinical Considerations
- The choice of anticoagulant therapy for patients with AFib should be individualized, taking into account the patient's risk factors, medical history, and other medications 4, 6.
- Apixaban may be a suitable option for patients with AFib who are at high risk of thrombosis and have a history of bioprosthetic valve replacement or valve repair 5.
- Regular monitoring of renal function is recommended for patients taking apixaban, as the anticoagulant action of apixaban is increased by renal failure 4.