Does Eliquis Decrease the Risk of Heart Attack?
No, Eliquis (apixaban) is not indicated for reducing the risk of heart attack and has not been shown to effectively prevent myocardial infarction. In fact, when tested specifically for acute coronary syndrome, the APPRAISE-2 trial was stopped early due to excess bleeding without evidence of efficacy 1.
Primary Indication: Stroke Prevention, Not Coronary Events
Apixaban is FDA-approved and guideline-recommended specifically for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, not for preventing heart attacks 1, 2. The ARISTOTLE trial demonstrated:
- 21% reduction in stroke or systemic embolism (1.27% vs 1.60% per year with warfarin; HR 0.79,95% CI 0.66-0.95) 1
- The benefit was primarily from a 49% reduction in hemorrhagic stroke, with only an 8% reduction in ischemic stroke 1
- No significant effect on myocardial infarction rates 1
Evidence Against Use in Acute Coronary Syndromes
The clinical trial data specifically addressing coronary events are discouraging:
- APPRAISE-2 trial compared apixaban 5 mg twice daily with placebo as an adjunct to antiplatelet therapy in 7,392 patients with acute coronary syndrome 1
- The trial was terminated early due to excess bleeding, including intracranial hemorrhage, when apixaban was combined with dual antiplatelet therapy 1
- No evidence of efficacy for preventing recurrent ischemic events was demonstrated 1
Myocardial Infarction Rates in Atrial Fibrillation Trials
In patients with atrial fibrillation who also had coronary artery disease:
- Rates of myocardial infarction were only numerically lower with apixaban compared to warfarin, but this was not statistically significant 3
- In cardioversion studies, the pooled relative risk for MI was 0.72 (95% CI 0.27-1.90), showing no significant benefit 1
What Apixaban Actually Does
Apixaban is a direct factor Xa inhibitor that prevents thrombus formation in the atrial appendage and venous system 2, 4. Its mechanism of action targets:
- Cardioembolic stroke from atrial fibrillation (highly effective) 1
- Venous thromboembolism (VTE treatment and prevention) 5
- NOT arterial thrombosis in coronary arteries (the mechanism of heart attacks)
Clinical Bottom Line
For patients concerned about heart attack prevention, the evidence-based interventions include:
- Antiplatelet agents (aspirin, P2Y12 inhibitors like clopidogrel)
- Statins
- Blood pressure control
- Lifestyle modifications
Apixaban should not be prescribed with the expectation of reducing heart attack risk 1. Its role is limited to preventing stroke in atrial fibrillation and treating/preventing venous thromboembolism 2, 5.