What is the use of Apixaban (Eliquis)?

From the Guidelines

Apixaban is a highly effective oral anticoagulant for preventing stroke in patients with nonvalvular atrial fibrillation, with a recommended dose of 5 mg twice daily for most patients, and 2.5 mg twice daily for those meeting specific criteria, as demonstrated in the ARISTOTLE trial 1. The use of apixaban has been extensively studied, and the evidence suggests that it is superior to aspirin for secondary prevention of stroke or systemic embolism, with a similar rate of major bleeding 1. The ARISTOTLE trial, a phase 3 randomized trial, compared apixaban to warfarin for the prevention of stroke or systemic embolization among patients with atrial fibrillation or atrial flutter and at least one additional risk factor for stroke, and found that apixaban was superior to warfarin in reducing the risk of stroke or systemic embolization, with a lower risk of major bleeding 1. Key benefits of apixaban include:

• Reduced risk of stroke or systemic embolism compared to warfarin and aspirin 1
• Lower risk of major bleeding compared to warfarin 1
• No requirement for routine blood monitoring, unlike warfarin
• Fewer food and drug interactions compared to warfarin
• Convenient dosing schedule, with a standard dose of 5 mg twice daily for most patients, and 2.5 mg twice daily for those meeting specific criteria, such as age 80 years or older, body weight 60 kg or less, or serum creatinine 1.5 mg/dL or higher 1. Common side effects of apixaban include:
• Increased risk of bleeding
• Bruising
• Nausea It is essential for patients to take apixaban with food and at approximately the same times each day, and not to stop taking it without consulting their healthcare provider due to the risk of stroke or other clotting events. Overall, apixaban is a highly effective and convenient oral anticoagulant for preventing stroke in patients with nonvalvular atrial fibrillation, with a favorable safety profile compared to warfarin and aspirin 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 use of Apixaban (Eliquis) is to:

• Reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
• Provide prophylaxis of 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.

From the Research

Use of Apixaban (Eliquis)

• Apixaban is used for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation 3, 4, 5.
• It has predictable pharmacodynamics and pharmacokinetics and does not require routine anticoagulation monitoring 3.
• Apixaban is also used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation who are at risk of stroke 6, 7.
• The medication has been shown to be effective in clinical trials, with a lower risk of major bleeding compared to warfarin 3, 6, 5.

Patient Characteristics

• Apixaban is often prescribed to older patients with higher bleeding risk and decreased renal function 4.
• Patients with stage ≥4 chronic kidney disease are less likely to be prescribed apixaban 4.
• The medication is also prescribed to patients with a higher CHA2DS2-VASc score, indicating a higher risk of stroke 4.

Dosage and Administration

• Apixaban is available in two doses: 5mg/day and 10mg/day 4.
• The dosage is often reduced in patients with decreased renal function or other comorbidities 4.
• However, off-label use of apixaban has been observed, mainly in elderly patients, despite normal renal function and weight 4.

Comparison with Other Anticoagulants

• Apixaban has been compared to other non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran and rivaroxaban, in clinical trials 6.
• The results suggest that apixaban may have a lower bleeding risk compared to rivaroxaban, but similar effectiveness in preventing stroke and systemic embolism 6.