From the Guidelines
Eliquis (apixaban) does not directly affect hemoglobin levels but may indirectly impact them through its primary mechanism as a blood thinner. As an anticoagulant that inhibits Factor Xa in the clotting cascade, Eliquis prevents blood clot formation by reducing thrombin production and fibrin clot development 1. While Eliquis itself doesn't alter hemoglobin production or structure, its anticoagulant effects can potentially lead to bleeding, which if significant, may cause hemoglobin levels to decrease. This occurs because blood loss reduces the total number of red blood cells in circulation. Some key points to consider when evaluating the impact of Eliquis on hemoglobin levels include:
- The risk of bleeding with Eliquis, as demonstrated in the ARISTOTLE trial, where apixaban was compared with warfarin in a double-blind RCT of 18,201 patients with AF and a mean CHADS 2 score of 2.1 1.
- The importance of monitoring for signs of bleeding, such as unusual bruising, prolonged bleeding from cuts, blood in urine or stool, and seeking immediate medical attention if these occur.
- The potential need for regular monitoring of complete blood counts, including hemoglobin levels, in patients on long-term Eliquis therapy, especially those with additional risk factors for bleeding or anemia. It is essential to weigh the benefits of Eliquis in preventing stroke and systemic embolism against the potential risks of bleeding and its indirect impact on hemoglobin levels, as demonstrated in the ARISTOTLE trial, where apixaban was significantly better than warfarin, with fewer overall strokes and major bleeding events 1.
From the FDA Drug Label
Hgb decrease ≥2 g/dL 13 (0.49%) 10 (0.38%) 8 (0.53%) 9 (0.60%) 10 (0.63%) 16 (1.01%) Anemia (including postoperative and hemorrhagic anemia, and respective laboratory parameters) 153 (2.6) 178 (3.0)
Hemoglobin levels can be affected by apixaban, as indicated by the presence of Hgb decrease ≥2 g/dL and anemia in the adverse reaction tables 2.
From the Research
Effect of Elliquis (Apixaban) on Hemoglobin
- Elliquis, also known as apixaban, is a novel oral anticoagulant used to prevent stroke and systemic embolism in patients with non-valvular atrial fibrillation 3.
- The relationship between apixaban and hemoglobin levels is not directly addressed in most studies, but some research suggests that low hemoglobin levels may be associated with an increased risk of bleeding in patients taking apixaban 4.
- A study published in 2017 found that anemia, defined as hemoglobin <13.0 g/dL in men and <12.0 g/dL in women, was associated with major bleeding and mortality, but not stroke, in patients with atrial fibrillation taking apixaban or warfarin 5.
- Another study found that low hemoglobin levels at baseline were associated with clinically relevant bleeding in cancer patients treated with apixaban for venous thromboembolism 4.
Bleeding Risk and Hemoglobin
- The risk of bleeding with apixaban is a concern, particularly in patients with renal impairment or a history of bleeding 3, 6, 7.
- Low hemoglobin levels may be a risk factor for bleeding in patients taking apixaban, particularly in those with cancer or renal impairment 4, 5.
- However, the benefits of apixaban in preventing stroke and systemic embolism appear to be consistent in patients with and without anemia 5.