Why is Eliquis (Apixaban) preferred by cardiologists?

From the Guidelines

Eliquis (Apixaban) is preferred by cardiologists due to its superior efficacy and safety profile compared to warfarin and aspirin in preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation.

Key Benefits of Apixaban

• Apixaban has been shown to be superior to warfarin in reducing the risk of stroke or systemic embolism, with a 19% reduction in stroke or systemic embolism and a 51% reduction in hemorrhagic stroke 1
• Apixaban also has a lower risk of major bleeding compared to warfarin, with a 10% overall reduction in mortality 1
• The ARISTOTLE trial demonstrated that apixaban was superior to warfarin in reducing the risk of stroke or systemic embolism, with a hazard ratio of 0.79 (95% CI, 0.66-0.95) 1

Clinical Recommendations

• The American College of Cardiology and American Heart Association recommend the use of direct-acting oral anticoagulants (DOACs), including apixaban, over warfarin in DOAC-eligible patients with atrial fibrillation (Class 1, Level of Evidence: A) 1
• The CHA2DS2-VASc score is recommended for assessing stroke risk in patients with atrial fibrillation, and selection of anticoagulant therapy should be based on the risk of thromboembolism 1

Important Considerations

• Apixaban is typically administered at a dose of 5 mg twice daily, unless the patient meets certain criteria for a lower dose of 2.5 mg twice daily, such as age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 1
• The use of apixaban should be individualized based on shared decision-making with the patient, taking into account the absolute risks and relative risks of stroke and bleeding, as well as the patient's values and preferences 1

From the FDA Drug Label

14 CLINICAL STUDIES 14. 1 Reduction of Risk of Stroke and Systemic Embolism in Nonvalvular Atrial Fibrillation ARISTOTLE

Evidence for the efficacy and safety of apixaban was derived from ARISTOTLE, a multinational, double-blind study in patients with nonvalvular AF comparing the effects of apixaban and warfarin on the risk of stroke and non-central nervous system (CNS) systemic embolism. Apixaban was superior to warfarin for the primary endpoint of reducing the risk of stroke and systemic embolism (Table 9 and Figure 4). Superiority to warfarin was primarily attributable to a reduction in hemorrhagic stroke and ischemic strokes with hemorrhagic conversion compared to warfarin. Apixaban also showed significantly fewer major bleeds than warfarin [see Adverse Reactions (6. 1)].

The reason Eliquis (Apixaban) may be preferred by cardiologists is due to its:

• Superior efficacy in reducing the risk of stroke and systemic embolism compared to warfarin, as demonstrated in the ARISTOTLE study 2.
• Lower risk of major bleeding compared to warfarin, which is a significant advantage in terms of safety.
• Reduced risk of hemorrhagic stroke and ischemic strokes with hemorrhagic conversion, which are potentially life-threatening complications.

From the Research

Reasons for Preference of Eliquis (Apixaban) by Cardiologists

• Eliquis (Apixaban) has been shown to significantly reduce stroke and systemic embolism (SE) in patients with subclinical atrial fibrillation, especially those with a CHA2DS2-VASc score >4, as demonstrated in the ARTESiA study 3.
• Apixaban has been found to have a lower risk of stroke/SE and major bleeding compared to warfarin in patients with nonvalvular atrial fibrillation, as shown in a study published in PloS one 4.
• The drug has a predictable pharmacokinetic profile, multiple pathways of elimination, and an improved bleeding profile relative to warfarin, making it an appealing option for cardiologists 5, 6.
• Apixaban has been found to be more effective than either aspirin or warfarin for stroke prevention in patients with atrial fibrillation, with a similar or improved safety profile 6.
• The drug has a rapid onset of action, a plasma elimination half-life of 12 hours, and can be administered in a twice-daily dosing regimen without the need for anticoagulation monitoring or dosage adjustment 6, 7.
• Apixaban has a low number of drug and food interactions, and a relatively wide therapeutic window, making it a convenient option for patients 7.