What is the use of Eliquis (Apixaban)?

From the Guidelines

Eliquis (apixaban) is a direct oral anticoagulant (DOAC) medication primarily used to prevent blood clots and reduce stroke risk in patients with atrial fibrillation, as well as to treat and prevent deep vein thrombosis and pulmonary embolism, with a recommended dosage of 5 mg taken twice daily, unless the patient meets specific criteria for a reduced dose of 2.5 mg twice daily 1. The medication works by inhibiting Factor Xa, a key enzyme in the blood clotting cascade, which prevents the formation of thrombin and subsequent clot development.

Key Points

• Eliquis has been shown to be superior to aspirin for secondary prevention of stroke or systemic embolism, with a similar rate of major bleeding 1.
• The ARISTOTLE trial demonstrated that apixaban was superior to warfarin for the prevention of stroke or systemic embolization among patients with AF or atrial flutter and at least 1 additional risk factor for stroke, with a reduced risk of hemorrhagic stroke and major bleeding 1.
• The typical dosage of 5 mg twice daily can be reduced to 2.5 mg twice daily for patients who meet at least two of the following criteria: age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 1.

Important Considerations

• Patients should never abruptly stop taking Eliquis without medical supervision due to increased stroke risk.
• Patients should inform all healthcare providers about taking this medication before any procedures.
• Common side effects include increased bleeding risk, bruising, and nosebleeds, and any signs of unusual bleeding should prompt immediate medical attention.

Clinical Use

• Eliquis is a valuable treatment option for patients with atrial fibrillation, particularly those who are at high risk of stroke or systemic embolism, and those who have had prior stroke or TIA.
• The medication's efficacy and safety profile make it a preferred choice over warfarin in many cases, especially for patients who are naive to vitamin K antagonists or have had difficulty with warfarin therapy in the past 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) 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 Eliquis (Apixaban) 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 reduce the risk of stroke and blood clots in people with atrial fibrillation
• It is used to reduce the risk of forming a blood clot in the legs and lungs of people who have just had hip or knee replacement surgery
• It is used to treat blood clots in the veins of the legs or lungs, and reduce the risk of them occurring again 2 2

From the Research

Use of Eliquis (Apixaban)

• Eliquis (Apixaban) is used to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation 3
• It is a direct factor Xa inhibitor with predictable pharmacodynamics and pharmacokinetics, and does not require routine anticoagulation monitoring 3
• Apixaban has been shown to be effective in preventing stroke and systemic embolism in patients with atrial fibrillation, with a lower risk of major bleeding compared to warfarin 4, 3
• The drug is administered twice daily, and its use is recommended for patients with nonvalvular atrial fibrillation who are at high risk of stroke 4, 5

Patient Subgroups

• Apixaban has been shown to be effective in various patient subgroups, including those with CHADS2 score ≥ 2, secondary stroke prevention, and high quality anticoagulation control with warfarin 6
• Patients with advanced age, low body weight, or renal dysfunction have a higher risk of stroke or systemic embolism and major bleeding, but show consistent benefits with apixaban compared to warfarin 7
• The 5 mg twice daily dose of apixaban is safe, efficacious, and appropriate for patients with only 1 dose-reduction criterion, such as advanced age, low body weight, or renal dysfunction 7

Comparison with Other Anticoagulants

• Apixaban has been compared to other novel oral anticoagulants (NOACs), such as dabigatran, rivaroxaban, and edoxaban, and has been shown to have a favorable efficacy and safety profile 4, 6
• The selection of apixaban over other NOACs should be based on individual patient characteristics, such as age, renal function, and bleeding risk 4, 5