Can Eliquis (apixaban) cause thrombocytopenia?

From the Guidelines

Eliquis (apixaban) can cause thrombocytopenia, although it is considered a rare side effect. Thrombocytopenia is a condition characterized by abnormally low platelet counts in the blood, which can increase the risk of bleeding. The mechanism behind Eliquis-induced thrombocytopenia is not fully understood but may involve immune-mediated reactions where the drug triggers antibody formation against platelets. According to the most recent study 1, apixaban is probably also an option for the treatment of heparin-induced thrombocytopenia (HIT), with a low risk of thrombosis and major bleeding.

Key Points to Consider

• Patients taking Eliquis who experience unusual bruising, petechiae (small red or purple spots on the skin), prolonged bleeding from cuts, blood in urine or stool, or unusually heavy menstrual bleeding should seek medical attention promptly.
• Regular blood count monitoring may be recommended for patients on long-term Eliquis therapy, especially those with other risk factors for thrombocytopenia.
• If thrombocytopenia develops, healthcare providers will evaluate the severity and may consider adjusting the dose or switching to an alternative anticoagulant.
• It's essential not to stop taking Eliquis without consulting a healthcare provider, as this could increase the risk of blood clots.
• The use of apixaban in patients with thrombocytopenia should be cautious, and the benefits and risks should be carefully weighed, as suggested by the study 1.

Management and Treatment

• In cases of suspected Eliquis-induced thrombocytopenia, healthcare providers should promptly evaluate the patient's condition and consider alternative anticoagulant therapy.
• The study 1 suggests that rivaroxaban and apixaban may be used as treatment options for HIT, with rivaroxaban being the most evaluated DOAC in this situation.
• However, the study 1 highlights the importance of careful dosing and monitoring in patients with renal impairment and thrombocytopenia.

Conclusion is not allowed, so the answer will be ended here.

From the FDA Drug Label

Less common adverse reactions in apixaban-treated patients undergoing hip or knee replacement surgery occurring at a frequency of ≥0.1%:

• lymphatic system disorders: thrombocytopenia (including platelet count decreases)

Thrombocytopenia is listed as a less common adverse reaction in apixaban-treated patients, occurring at a frequency of ≥0.1%. This indicates that Eliquis (apixaban) can cause thrombocytopenia 2.

From the Research

Eliquis and Thrombocytopenia

• Eliquis, also known as apixaban, is a direct oral anticoagulant used to prevent or treat thrombosis in various situations 3.
• While apixaban is effective in treating venous thromboembolism, there are some populations where its use has not been extensively studied, including patients with a history of heparin-induced thrombocytopenia or identified forms of thrombophilia 4.
• A case report has been published detailing apixaban-induced thrombocytopenia, highlighting the need for clinicians to be aware of this potential side effect 5.
• In patients with venous thromboembolism and risk factors for bleeding or recurrences, apixaban has been shown to be effective and safe, with a lower risk of recurrent VTE, major bleeding, and clinically relevant non-major bleeding compared to warfarin 6.
• However, the management of venous thromboembolism in patients with thrombocytopenia is clinically challenging, and expert consensus recommends using dose-adjusted low molecular weight heparin according to platelet count to optimize anticoagulant treatment in patients at high bleeding risk 7.

Key Findings

• Apixaban can cause thrombocytopenia, although this is an uncommon side effect 5.
• The use of apixaban in patients with a history of heparin-induced thrombocytopenia or identified forms of thrombophilia has not been extensively studied 4.
• Apixaban is effective and safe in patients with venous thromboembolism and risk factors for bleeding or recurrences, with a lower risk of recurrent VTE and bleeding compared to warfarin 6.
• Expert consensus recommends using dose-adjusted low molecular weight heparin according to platelet count to optimize anticoagulant treatment in patients at high bleeding risk 7.