From the Guidelines
Eliquis (apixaban) significantly reduces the risk of stroke in patients with atrial fibrillation, with an annual stroke rate of approximately 1.27% compared to 1.60% with warfarin, as demonstrated in the ARISTOTLE trial 1. The reduction in stroke rate is primarily due to the reduction in hemorrhagic stroke, with a 49% reduction compared to warfarin. Key benefits of Eliquis include:
- A lower risk of major bleeding, particularly intracranial hemorrhage, with a hazard ratio of 0.69 compared to warfarin 1
- No requirement for regular blood monitoring, unlike warfarin
- A consistent treatment effect across prespecified subgroups, including those based on concurrent aspirin use, warfarin use before study enrollment, and prior stroke or TIA status 1 The standard dosage of Eliquis is 5 mg twice daily for most patients, though a reduced dose of 2.5 mg twice daily is recommended for patients meeting at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 1. It is essential for patients to take Eliquis consistently without missing doses, as its anticoagulant effect diminishes within 24 hours of the last dose. Additionally, patients should inform all healthcare providers about taking Eliquis before any procedures to manage bleeding risk appropriately. Overall, Eliquis is a highly effective and safe option for stroke prevention in patients with atrial fibrillation, with a significant reduction in stroke rate and major bleeding risk compared to warfarin 1.
From the FDA Drug Label
Apixaban was superior to warfarin for the primary endpoint of reducing the risk of stroke and systemic embolism (Table 9 and Figure 4). Table 9: Key Efficacy Outcomes in Patients with Nonvalvular Atrial Fibrillation in ARISTOTLE (Intent-to-Treat Analysis) Apixaban N=9120 n (%/year) Warfarin N=9081 n (%/year) Hazard Ratio (95% CI)P-value Stroke or systemic embolism 212 (1.27) 265 (1.60) 0.79 (0.66, 0.95) 0.01 Stroke 199 (1.19) 250 (1.51) 0.79 (0.65, 0.95)
The stroke rate with Eliquis (apixaban) is 1.19% per year in patients with nonvalvular atrial fibrillation, as demonstrated in the ARISTOTLE study 2.
- The ischemic stroke rate without hemorrhage was 0.83% per year.
- The hemorrhagic stroke rate was 0.24% per year.
From the Research
Stroke Rate with Eliquis (Apixaban)
- The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial showed that apixaban is better than warfarin at prevention of stroke or systemic embolism, causes less bleeding, and results in lower mortality 3.
- The study found that apixaban significantly reduced stroke or systemic embolism with no evidence of a differential effect by risk of stroke (CHADS(2) 1, 2, or ≥3, p for interaction=0·4457; or CHA(2)DS(2)VASc 1, 2, or ≥3, p for interaction=0·1210) or bleeding (HAS-BLED 0-1, 2, or ≥3, p for interaction=0·9422) 3.
- Another study found that patients with atrial fibrillation and isolated 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 the 5 mg twice daily dose of apixaban vs warfarin compared with patients without these characteristics 4.
- A study comparing low-dose and standard-dose apixaban found that low-dose apixaban was associated with a greater risk of stroke/SE and death without a reduction in the bleeding rates 5.
- In patients with moderate chronic kidney disease, apixaban significantly reduced primary events by 68% (5.6% per year on aspirin v 1.8% per year on apixaban; HR 0.32; 95% confidence interval [CI] 0.18-0.55; P < .001) compared to aspirin 6.
- A real-life study found that underdosing with apixaban is very common, and may not disproportionately elevate the risk of ischemic stroke, but patients treated with reduced apixaban dose seem to be at higher risk for major bleeding 7.