Can stroke occur while on Eliquis (apixaban)?

From the Guidelines

Yes, stroke can still occur while on Eliquis (apixaban), although the medication significantly reduces the risk of stroke, particularly in people with atrial fibrillation. Eliquis works by inhibiting Factor Xa, which helps prevent blood clot formation, but it's not 100% effective in all situations 1. The ARISTOTLE trial, a double-blind RCT of 18,201 patients with AF, demonstrated that apixaban was significantly better than warfarin, with fewer overall strokes (both ischemic and hemorrhagic), systemic emboli, and major bleeding events 1. However, this does not mean that stroke is completely eliminated, and some patients may experience breakthrough strokes due to various factors, including missed doses, drug interactions that reduce Eliquis effectiveness, or strokes caused by mechanisms other than blood clots (such as hemorrhagic strokes) 1.

Some key points to consider when taking Eliquis include:

• Taking the medication exactly as prescribed (typically 5mg twice daily, though some patients may receive 2.5mg twice daily based on age, weight, or kidney function) 1
• Not missing doses, as this can increase the risk of stroke 1
• Maintaining regular follow-up appointments with your healthcare provider to monitor the effectiveness of the medication and adjust the treatment plan as needed 1
• Reporting any unusual symptoms immediately, such as signs of stroke or bleeding 1
• Continuing to manage other stroke risk factors, such as high blood pressure, diabetes, smoking, and high cholesterol, as Eliquis only addresses the clotting aspect of stroke prevention 1

It's also important to note that patients with severe and end-stage CKD (serum creatinine >2.5 mg/dL or CrCl <25 mL/min) were excluded from the ARISTOTLE and AVERROES trials, and prescribing recommendations for apixaban in these patients are limited 1. Therefore, it's crucial to work closely with your healthcare provider to determine the best treatment plan for your individual needs.

From the FDA Drug Label

For people taking apixaban tablets for atrial fibrillation: People with atrial fibrillation (a type of irregular heartbeat) are at an increased risk of forming a blood clot in the heart, which can travel to the brain, causing a stroke, or to other parts of the body. Apixaban lowers your chance of having a stroke by helping to prevent clots from forming Stopping apixaban increases your risk of having a stroke.

Yes, stroke can occur while on Eliquis (apixaban), especially if the medication is stopped. Apixaban is intended to lower the chance of having a stroke by preventing clots from forming. If apixaban is stopped, the risk of stroke increases 2.

From the Research

Stroke Occurrence on Eliquis (Apixaban)

• The studies provide evidence on the efficacy and safety of apixaban in preventing stroke and systemic embolism in patients with atrial fibrillation 3, 4, 5, 6.
• According to the ARISTOTLE trial, apixaban was effective in reducing stroke or systemic embolism compared to warfarin, with a hazard ratio (HR) of 0.79 (95% CI, 0.66-0.95) 3.
• The study also found that patients with 1 dose-reduction criterion had higher rates of stroke or systemic embolism (HR, 1.47; 95% CI, 1.20-1.81) and major bleeding (HR, 1.89; 95% CI, 1.62-2.20) compared to those with no dose-reduction criteria 3.
• Another study found that apixaban prevented 1.28 (95% CI: 0.43-2.12) strokes/systemic embolism per 100 patient-years and caused 0.68 (95% CI: -0.23 to 1.57) major bleeds in patients with CHA2DS2-VASc >4 4.
• A network meta-analysis found that apixaban may result in little to no difference in all-cause mortality, cardiovascular mortality, stroke, and major bleeding compared to vitamin K antagonists (VKAs) in people with an indication for anticoagulation after transcatheter aortic valve replacement (TAVR) 7.
• A systematic review and meta-analysis of real-world studies found that apixaban was associated with a lower risk of major bleeding and intracranial hemorrhage compared to warfarin, dabigatran, and rivaroxaban 6.

Key Findings

• Apixaban is effective in reducing stroke or systemic embolism in patients with atrial fibrillation 3, 4, 5, 6.
• Patients with 1 dose-reduction criterion have higher rates of stroke or systemic embolism and major bleeding compared to those with no dose-reduction criteria 3.
• Apixaban has a better safety profile compared to warfarin, dabigatran, and rivaroxaban in terms of major bleeding and intracranial hemorrhage 6.
• The efficacy and safety of apixaban in preventing stroke and systemic embolism are consistent across different patient populations, including those with and without an indication for anticoagulation after TAVR 7.