Eliquis (apixaban) is a prescription anticoagulant medication specifically engineered to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. It represents a significant advancement in oral anticoagulation therapy, offering a targeted mechanism of action that directly inhibits Factor Xa, a key component in the blood coagulation cascade. This direct inhibition provides a predictable anticoagulant effect, which is a cornerstone of its clinical profile. Its development was grounded in extensive clinical research, culminating in robust trial data that supports its efficacy and safety in a defined patient population.

Features

• Active pharmaceutical ingredient: Apixaban
• Pharmacologic class: Direct Factor Xa inhibitor
• Standard dosage forms: 2.5 mg and 5 mg film-coated oral tablets
• Rapid onset of action; peak plasma concentrations reached within 3-4 hours post-administration
• Terminal elimination half-life of approximately 12 hours
• Dual excretion pathway: approximately 25% renal and the remainder hepatobiliary/fecal
• No requirement for routine coagulation monitoring (e.g., INR testing) in most patients

Benefits

• Superior Stroke Risk Reduction: Demonstrated significant superiority over warfarin in reducing the risk of stroke or systemic embolism in patients with non-valvular atrial fibrillation.
• Major Bleeding Risk Reduction: Associated with a significantly lower risk of major bleeding, including intracranial hemorrhage, compared to warfarin, as established in pivotal clinical trials.
• Predictable Pharmacokinetics: Its direct mechanism of action and consistent anticoagulant effect eliminate the need for frequent blood draws and dosage adjustments, simplifying patient management.
• Fewer Drug and Food Interactions: Has fewer known dietary restrictions (e.g., no interaction with vitamin K) and a lower potential for certain drug interactions compared to vitamin K antagonists.
• Fixed Dosing Regimen: The standard twice-daily dosing is fixed, enhancing patient adherence and reducing the complexity of treatment protocols.
• Rapid Offset: The anticoagulant effect declines in a predictable manner within 24 hours of the last dose in patients with normal renal and hepatic function, which can be advantageous in managing bleeding events or prior to procedures.

Common use

Eliquis is primarily indicated to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. It is also approved for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery. Furthermore, it is used for the treatment of DVT and PE and for the reduction in the risk of recurrent DVT and PE following initial therapy.

Dosage and direction

The recommended dosage for stroke reduction in non-valvular atrial fibrillation is 5 mg taken orally twice daily. For patients with at least two of the following characteristics: age 80 years or older, body weight 60 kg or less, or serum creatinine 1.5 mg/dL or greater, the recommended dose is 2.5 mg orally twice daily. For post-orthopedic surgery prophylaxis, the typical dose is 2.5 mg twice daily, initiated 12 to 24 hours post-surgery. For the treatment and secondary prevention of DVT/PE, the dose is 10 mg twice daily for 7 days, followed by 5 mg twice daily. Tablets should be swallowed whole with water, with or without food. Adherence to the twice-daily schedule is critical for maintaining effective anticoagulation.

Precautions

Patients should be advised that they may bruise more easily and it may take longer for bleeding to stop. They should be vigilant for signs of bleeding or anemia, such as unusual weakness, dizziness, red or dark brown urine, or red or black stools. Care should be taken when using sharp objects like razors or nail clippers. Inform all healthcare providers, including dentists, that you are taking Eliquis before any surgery, medical procedure, or dental work. Spinal or epidural hematomas, which can result in long-term or permanent paralysis, may occur in patients treated with Eliquis who are receiving neuraxial anesthesia or undergoing spinal puncture; these patients should be monitored frequently for signs and symptoms of neurological impairment. The use of Eliquis is not recommended in patients with prosthetic heart valves or in patients with atrial fibrillation associated with mitral stenosis.

Contraindications

Eliquis is contraindicated in patients with active pathological bleeding. It is also contraindicated in patients with severe hypersensitivity reaction to apixaban (e.g., anaphylactic reactions). Its use in patients with triple-positive antiphospholipid syndrome (APS) is contraindicated due to an increased risk of recurrent thrombotic events.

Possible side effect

The most common and serious side effect, as with all anticoagulants, is bleeding, which can range from minor to severe and life-threatening. Possible side effects include:

• Serious Bleeding: Gastrointestinal bleeding, intracranial hemorrhage, hemorrhagic stroke, prolonged bleeding from wounds.
• Common Side Effects: Nausea, anemia, bruising more easily, minor bleeding (e.g., nosebleeds, bleeding gums).
• Hypersensitivity Reactions: Rash, pruritus (itching), and in rare cases, anaphylaxis.
• Other: Postprocedural hemorrhage, hematoma, hematuria (blood in urine), conjunctival hemorrhage.

Drug interaction

Concomitant use of drugs that affect hemostasis increases the risk of bleeding. These include:

• Strong Dual Inhibitors of CYP3A4 and P-gp: Drugs like ketoconazole, itraconazole, ritonavir, or clarithromycin significantly increase apixaban exposure. Concomitant use is not recommended.
• Antiplatelet Agents, NSAIDs, SSRIs/SNRIs: Aspirin, clopidogrel, ibuprofen, naproxen, sertraline, etc., increase the risk of bleeding. Use with caution and only if the potential benefit justifies the risk.
• Other Anticoagulants: Concomitant use with heparin, warfarin, or other direct oral anticoagulants is typically avoided due to a profound increase in bleeding risk.
• Strong Inducers of CYP3A4 and P-gp: Drugs like rifampin, carbamazepine, phenytoin, and St. John’s Wort can significantly decrease apixaban exposure, reducing its efficacy, and should be co-administered with caution.

Missed dose

If a dose is missed, the patient should take it as soon as possible on the same day. The dose should not be doubled to make up for a missed dose. Patients should resume their usual twice-daily schedule the following day.

Overdose

Overdose presents as an elevated risk of hemorrhage. There is no specific antidote for apixaban overdose. In the event of bleeding complications or suspected overdose, discontinue Eliquis immediately. Management should be individualized based on the severity and location of the bleeding and may include supportive measures, mechanical compression, surgical hemostasis, blood product transfusion (packed red blood cells, fresh frozen plasma), and symptomatic treatment. The use of procoagulant agents like prothrombin complex concentrate (PCC), activated prothrombin complex concentrate (aPCC), or recombinant Factor VIIa may be considered, but their use has not been evaluated in clinical trials. Apixaban is dialyzable to a limited extent (approximately 14% removal over 4 hours).

Storage

Store Eliquis tablets at room temperature between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F). Keep the bottle tightly closed and stored in its original container. Keep out of reach of children and pets. Do not use after the expiration date printed on the bottle.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting or stopping any medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has been compiled from various sources believed to be accurate but cannot be guaranteed. The manufacturer’s official prescribing information should be consulted for complete details.

Reviews

• Clinical Perspective (Cardiologist): “In my practice, Eliquis has become a first-line option for stroke prevention in appropriate AFib patients. The ARISTOTLE trial data is compelling, demonstrating not only non-inferiority but superiority to warfarin in efficacy with a superior safety profile regarding major bleeding. The fixed dosing and lack of routine monitoring are significant advantages for patient quality of life and adherence.”
• Patient Experience (72-year-old with AFib): “Switching from warfarin to Eliquis was life-changing. No more weekly blood tests or constantly worrying about what I eat. I take two pills a day and get on with my life. I haven’t had any issues with bleeding, just the occasional minor bruise, which is a small price to pay for peace of mind against a stroke.”
• Pharmacological Review: “Apixaban’s 12-hour half-life and ~25% renal excretion make it a viable option for patients with mild to moderate renal impairment, though dose adjustment is necessary in severe renal dysfunction. Its predictable pharmacokinetics are a major step forward from the variability seen with VKAs.”