From the Guidelines
Eliquis (apixaban) monitoring is generally not required for routine use, unlike traditional anticoagulants such as warfarin, due to its predictable pharmacokinetics and wide therapeutic window, as demonstrated in the ARISTOTLE trial 1. The standard dosing for most patients with atrial fibrillation is 5 mg twice daily, with a reduced dose of 2.5 mg twice daily for patients meeting at least two of these criteria: age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. Some key points to consider when monitoring patients on Eliquis include:
- Regular follow-up appointments to assess for bleeding complications, medication adherence, and kidney function
- Kidney function should be checked at least annually, or more frequently in patients with declining renal function, as Eliquis is partially eliminated by the kidneys
- Patients should be monitored for signs of bleeding such as unusual bruising, nosebleeds, blood in urine or stool, and severe headaches The ARISTOTLE trial demonstrated that apixaban was significantly better than warfarin, with fewer overall strokes, systemic emboli, and major bleeding events, and the AVERROES study showed that apixaban was superior to aspirin for preventing the occurrence of any stroke or systemic embolism 1. Key considerations for patient care include:
- The benefit of apixaban was independent of type of AF, risk profile, CHADS 2 or CHA 2DS -VASc score, and whether there was a prior stroke
- Patients with severe and end-stage CKD (serum creatinine >2.5 mg/dL or CrCl <25 mL/min) were excluded from the ARISTOTLE and AVERROES trials, and prescribing recommendations for apixaban were revised for use in patients with end-stage CKD who were maintained on stable hemodialysis.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Eliquist Monitoring
Eliquist monitoring is not directly mentioned in the provided studies. However, the studies discuss the monitoring and management of bleeding risk in patients taking anticoagulants such as apixaban.
Bleeding Risk Management
- The study 2 highlights the importance of bleeding risk management in patients taking anticoagulants, including apixaban.
- The study 3 compares the major bleeding risk among non-valvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban, or warfarin, and finds that apixaban and dabigatran are associated with lower major bleeding risk compared to warfarin or rivaroxaban.
- The study 4 compares the safety and effectiveness of apixaban versus warfarin for acute venous thromboembolism in patients with end-stage kidney disease, and finds that apixaban is associated with a lower risk of major bleeding, intracranial bleeding, and gastrointestinal bleeding.
- The study 5 compares the major bleeding risk among newly anticoagulated non-valvular atrial fibrillation patients initiating apixaban, warfarin, dabigatran, or rivaroxaban, and finds that initiation with rivaroxaban or warfarin is associated with a significantly greater risk of major bleeding compared to initiation on apixaban.
Anticoagulant Therapy
- The study 6 investigates the effects of extended phase use of apixaban on the risk of recurrent venous thromboembolism and major bleeding events, and finds that there are no detected differences in recurrent venous thromboembolism or major bleeding events between patients prescribed low versus full dose apixaban.
- The study 2 discusses the use of apixaban as a new oral anticoagulant, and highlights its lower probability of bleeding compared to warfarin.