What is the diagnosis for the use of Eliquis (apixaban)?

From the Guidelines

Eliquis (apixaban) is primarily used to prevent blood clots in patients with atrial fibrillation not caused by heart valve problems, reducing stroke risk, and is recommended for patients with an elevated CHA2DS2-VASc score of 2 or greater in men or 3 or greater in women 1.

Indications for Use

The primary indications for Eliquis (apixaban) include:

• Prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
• Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Prevention of recurrence of DVT and PE

Dosage and Administration

The standard dosage for atrial fibrillation is typically 5 mg taken twice daily, though some patients may require a reduced dose of 2.5 mg twice daily based on age, weight, or kidney function 1. For DVT/PE treatment, patients usually start with 10 mg twice daily for 7 days, followed by 5 mg twice daily.

Important Considerations

• Eliquis should be taken consistently at the same times each day, with or without food
• Patients should not stop taking Eliquis without consulting their healthcare provider as this could increase clot risk
• Common side effects include bleeding risk, bruising, and nausea
• Eliquis works by inhibiting Factor Xa, a key component in blood clot formation, effectively preventing new clots while allowing the body to dissolve existing ones naturally

Renal Function Considerations

Renal function should be evaluated before initiation of apixaban and reevaluated at least annually, with more frequent evaluation recommended in patients with impaired renal function (CrCl < 60 mL/min) 1.

Key Recommendations

• Apixaban is recommended over warfarin in NOAC-eligible patients with atrial fibrillation (except with moderate-to-severe mitral stenosis or a mechanical heart valve) 1
• The CHA2DS2-VASc score is recommended for assessment of stroke risk in patients with atrial fibrillation 1
• Selection of anticoagulant therapy should be based on the risk of thromboembolism, irrespective of whether the AF pattern is paroxysmal, persistent, or permanent 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) The diagnosis for the use of Eliquis (apixaban) includes:

• Nonvalvular atrial fibrillation to reduce the risk of stroke and systemic embolism
• Deep vein thrombosis (DVT) prophylaxis in patients who have undergone hip or knee replacement surgery
• DVT and pulmonary embolism (PE) treatment
• Recurrent DVT and PE reduction following initial therapy 2

From the Research

Diagnosis for the Use of Eliquis (Apixaban)

The diagnosis for the use of Eliquis (apixaban) includes:

• Nonvalvular atrial fibrillation (AF) for the prevention of stroke and systemic embolism 3, 4
• Venous thromboembolism (VTE) 5, 6
• Left ventricular thrombi (LVTs) treatment 7
• Patients with severe left ventricular dysfunction and advanced heart failure 7
• Patients with chronic kidney disease (CKD) 7, 6

Patient Characteristics

Patient characteristics that may affect apixaban dosing include:

• Age 3, 4
• Weight 3, 4
• Renal function 7, 3, 6
• Serum creatinine level 3, 6
• Creatinine clearance 6

Dosing Considerations

Dosing considerations for apixaban include:

• Standard dose: 5 mg twice daily 3, 5, 6
• Reduced dose: 2.5 mg twice daily 3, 6, 4
• Increasing dose: used in some patients with LVTs 7
• Dose adjustment criteria (DAC) including age, body weight, and renal function 5