From the Guidelines
Eliquis (apixaban) should be used with caution in patients with acute kidney injury (AKI), as it is contraindicated in patients with stage IV/V chronic kidney disease (CrCl <30 mL/min) 1. For patients with AKI, the medication may need to be temporarily discontinued or the dose adjusted depending on the severity of kidney dysfunction. Eliquis is partially eliminated by the kidneys, so when kidney function declines during AKI, the drug can accumulate in the body and potentially increase bleeding risk. Some key points to consider when using Eliquis in patients with AKI include:
- Contraindications: pregnancy or breastfeeding, stage IV/V chronic kidney disease, active/clinically significant liver disease 1
- Relative contraindications: compromised renal or liver function, genitourinary or GI tract lesions, pathology, or instrumentation 1
- Dose adjustments: may be necessary for patients with severe renal dysfunction (CrCl <30 mL/min) 1
- Monitoring: close monitoring of kidney function and bleeding risk is recommended for patients with AKI taking Eliquis 1 Patients with severe AKI (creatinine clearance less than 15 mL/min) or those requiring dialysis should generally avoid Eliquis altogether. If you have AKI and are taking Eliquis, contact your healthcare provider immediately for evaluation and possible dose adjustment. They will likely monitor your kidney function closely with blood tests and assess your individual bleeding risk versus the benefit of continuing anticoagulation. Alternative anticoagulants with less kidney-dependent clearance might be considered during periods of acute kidney dysfunction. Once kidney function improves, your doctor may restart Eliquis at the appropriate dose based on your updated kidney function. It's worth noting that the most recent guidelines from 2024 provide the most up-to-date information on the use of Eliquis in patients with AKI 1.
From the Research
Eliquis Safety with Acute Kidney Injury (AKI)
- The safety of Eliquis (apixaban) in patients with acute kidney injury (AKI) has been evaluated in several studies 2, 3, 4, 5, 6.
- A study published in Pharmacotherapy found that patients with AKI who received factor Xa inhibitors, including apixaban, had a lower risk of bleeding events compared to those who received unfractionated heparin (UFH) 2.
- Another study published in The Annals of Pharmacotherapy found that apixaban use in patients with AKI resulted in a higher than normally reported incidence of major bleeding, and concomitant antiplatelet use increased the risk of bleeding 3.
- A case series published in the American Journal of Health-System Pharmacy found that monitoring specific anti-Xa levels in patients with AKI taking apixaban or rivaroxaban helped to transition them to unfractionated heparin infusions safely 4.
- A study published in Kidney Research and Clinical Practice reported a case of anticoagulant-related nephropathy associated with apixaban, highlighting the need for monitoring kidney function after initiation of anticoagulant therapy 5.
- A retrospective study published in The Annals of Pharmacotherapy found that anti-Xa level monitoring was associated with a significant reduction in major bleeding compared to standard monitoring in patients with AKI who received apixaban or rivaroxaban 6.
Key Findings
- Apixaban may be associated with a higher risk of bleeding in patients with AKI, especially when used concomitantly with antiplatelet agents 3.
- Monitoring specific anti-Xa levels may help to safely transition patients with AKI from apixaban or rivaroxaban to unfractionated heparin infusions 4.
- Anti-Xa level monitoring may be associated with a reduced risk of major bleeding in patients with AKI who receive apixaban or rivaroxaban 6.
- Patients with AKI who receive apixaban or rivaroxaban should be closely monitored for bleeding events and kidney function 2, 3, 5, 6.