What are the alternatives to Eliquis (apixaban)?

From the Guidelines

The most suitable alternative to Eliquis (apixaban) for anticoagulation therapy is Xarelto (rivaroxaban), as it is a direct oral anticoagulant (DOAC) with a similar mechanism of action and has been shown to be effective in preventing stroke and systemic embolism in patients with atrial fibrillation 1. When considering alternatives to Eliquis, it is essential to evaluate the patient's individual risk factors, kidney function, and potential drug interactions. The choice of anticoagulant should be based on the risk of thromboembolism, irrespective of whether the AF pattern is paroxysmal, persistent, or permanent 1. Some key points to consider when selecting an alternative to Eliquis include:

• DOACs, such as rivaroxaban, dabigatran, and edoxaban, are preferred over warfarin due to their more predictable anticoagulation effects and lower risk of serious bleeding 1.
• The CHA2DS2-VASc score is recommended for assessing stroke risk in patients with atrial fibrillation, and anticoagulant therapy should be individualized based on shared decision-making and discussion of the absolute risks and relative risks of stroke and bleeding 1.
• Reevaluation of the need for and choice of anticoagulant therapy at periodic intervals is recommended to reassess stroke and bleeding risks 1.
• In patients with atrial fibrillation, anticoagulant therapy should be continued according to the patient's individual risk of thromboembolism, irrespective of whether they are in AF or sinus rhythm 1. It is crucial to note that any switch between anticoagulants should only be done under medical supervision, as improper transitions can increase bleeding or clotting risks. Additionally, the use of reversal agents, such as idarucizumab and andexanet alfa, may be necessary in cases of serious bleeding or urgent surgery 1.

From the Research

Alternatives to Eliquis

• Apixaban (Eliquis) is a direct factor Xa inhibitor used to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation 2.
• Other alternatives to Eliquis include dabigatran, rivaroxaban, and edoxaban, which are also direct oral anticoagulants (DOACs) 3, 4.
• These DOACs have similar efficacy and safety profiles, but may differ in their dosing regimens, with some being administered once daily (edoxaban and rivaroxaban) and others twice daily (dabigatran and apixaban) 3, 5.

Comparison of DOACs

• A systematic review and meta-analysis found no difference in major thrombotic events or major bleeding between once-daily and twice-daily dosing regimens of DOACs 5.
• A study comparing dabigatran, rivaroxaban, and apixaban found no differences in the risk of stroke or systemic embolism, but apixaban was associated with a lower risk of major bleeding 6.
• Another study found that apixaban was associated with a lower risk of intracranial hemorrhage compared to warfarin 2.

Considerations for Choosing an Alternative

• The selection of a DOAC should be tailored to the individual patient, taking into account factors such as dosing regimen, efficacy, and safety profile 3, 4.
• Once-daily dosing regimens may improve adherence and persistence to therapy, but may also have a greater impact on anticoagulation if a dose is missed 3, 5.
• The choice of DOAC should be based on the individual patient's needs and characteristics, as well as the availability of evidence supporting the use of each medication 4, 6.