From the Guidelines
Patients can be switched from Lovenox (enoxaparin) to Eliquis (apixaban) after at least 5 days of initial parenteral anticoagulation with Lovenox for venous thromboembolism (VTE) treatment, or directly for atrial fibrillation patients, by discontinuing Lovenox and starting Eliquis at the time the next scheduled dose of Lovenox would have been given. The decision to switch should be based on the patient's clinical stability and ability to take oral medications. When switching, it is essential to consider the patient's renal function, as Eliquis requires dose adjustments or may be contraindicated in severe renal impairment 1. The standard Eliquis dosing for VTE is 10 mg twice daily for 7 days, followed by 5 mg twice daily, while for atrial fibrillation it's typically 5 mg twice daily (or 2.5 mg twice daily for patients meeting dose reduction criteria such as age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL) 1. Some key points to consider when making this switch include:
- Ensuring the patient has normal renal function before switching, as Eliquis requires dose adjustments or may be contraindicated in severe renal impairment 1
- Considering the patient's clinical stability and ability to take oral medications
- Following the recommended dosing regimen for Eliquis, as outlined in the NCCN guidelines 1
- Being aware of the potential for bleeding complications and monitoring the patient accordingly 1 It is crucial to prioritize the patient's morbidity, mortality, and quality of life when making this decision, and to consult the prescribing information for protocols on transitioning between agents 1.
From the Research
Switching from Lovenox to Eliquis
- The decision to switch a patient from Lovenox (enoxaparin) to Eliquis (apixaban) depends on various factors, including the patient's medical condition, treatment goals, and individual response to therapy 2, 3.
- Apixaban has been shown to be effective in preventing recurrent venous thromboembolism (VTE) and reducing the risk of major bleeding compared to traditional anticoagulants like warfarin and enoxaparin 2, 4, 5, 6.
- In patients with active cancer and VTE, extended treatment with reduced-dose apixaban (2.5 mg twice daily) has been found to be noninferior to full-dose apixaban (5 mg twice daily) in preventing recurrent VTE, with a lower incidence of clinically relevant bleeding complications 4.
- A systematic review and network meta-analysis of novel oral anticoagulants (NOACs) found that apixaban had a favorable safety profile, with a statistically significantly reduced risk of major or clinically relevant non-major bleeding compared to other NOACs like rivaroxaban, dabigatran, and edoxaban 6.
- When switching from Lovenox to Eliquis, it is essential to consider the patient's renal function, as apixaban is contraindicated in patients with severe renal impairment (creatinine clearance < 15 mL/min) 5.
- The timing of the switch depends on the patient's individual circumstances, but it is generally recommended to switch after the patient has completed the initial treatment phase with Lovenox and has been stabilized on the medication 3, 5.