Does Eliquis (apixaban) cause fluid retention?

From the Guidelines

Eliquis (apixaban) is not commonly associated with fluid retention as a side effect, and there is no strong evidence to suggest it causes significant fluid retention in patients 1. When considering the use of Eliquis, it's essential to weigh the benefits of anticoagulation against potential side effects. The mechanism of action of Eliquis as an anticoagulant is through the inhibition of factor Xa, which does not have a direct link to fluid balance in the body. Key points to consider regarding Eliquis and fluid retention include:

• Eliquis is primarily used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, and its efficacy and safety have been established in several clinical trials, including the ARISTOTLE trial 1.
• Common side effects of Eliquis include bleeding-related events, but fluid retention is not typically highlighted as a significant concern 1.
• If a patient on Eliquis experiences symptoms suggestive of fluid retention, such as swelling, weight gain, or shortness of breath, it is crucial to investigate whether these symptoms are related to the medication or to an underlying condition like heart failure or renal impairment.
• Management of suspected fluid retention in patients on Eliquis would involve a thorough clinical evaluation, potentially including dosage adjustment of Eliquis, the use of diuretics, or consideration of alternative anticoagulant therapies, always under the guidance of a healthcare provider. It is critical for patients to not stop taking Eliquis without consulting their doctor, as this can increase the risk of thromboembolic events 1.

From the Research

Eliquis (Apixaban) and Fluid Retention

• There are no direct studies that investigate the relationship between Eliquis (apixaban) and fluid retention 2, 3, 4, 5, 6.
• The available studies focus on the safety and efficacy of apixaban in patients with severe renal impairment, comparing it to warfarin in terms of bleeding risks, stroke, and systemic embolism 2, 3, 4, 5, 6.
• Although the studies do not mention fluid retention as a specific outcome, they do discuss the pharmacokinetics and clinical outcomes of apixaban in patients with kidney impairment, which may be relevant to understanding potential effects on fluid balance 5.
• However, without direct evidence, it is not possible to determine whether Eliquis (apixaban) causes fluid retention based on the provided studies 2, 3, 4, 5, 6.

Key Findings from Available Studies

• Apixaban appears to be a reasonable alternative to warfarin in patients with severe renal impairment, with similar or lower risks of bleeding and thromboembolic events 2, 3, 4, 6.
• The studies suggest that apixaban can be safely used in patients with end-stage renal disease (ESRD) or those requiring dialysis, although clinician experience and knowledge of patient-specific factors are important in managing these patients 4, 5.
• The available evidence supports the approved label dosing strategy of apixaban for reducing the risk of stroke/systemic embolism in patients with nonvalvular atrial fibrillation and for treating venous thromboembolism across all ranges of kidney function 5, 6.