Eliquis

Eliquis (apixaban) is a prescription anticoagulant medication specifically engineered to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. As a direct factor Xa inhibitor, it represents a significant advancement in oral anticoagulation therapy, offering a targeted mechanism of action that provides effective thromboembolic protection. Its clinical profile is supported by extensive research and major cardiovascular outcome trials, establishing it as a cornerstone therapy in modern cardiology and hematology practice. This medication requires careful patient selection and ongoing management to ensure optimal therapeutic outcomes while mitigating bleeding risks.

Features

• Active Ingredient: Apixaban
• Pharmacologic Class: Direct Factor Xa Inhibitor
• Dosage Forms: Oral tablets (2.5 mg and 5 mg)
• Dosing Regimen: Twice daily administration
• Onset of Action: Rapid absorption with peak plasma concentrations within 3-4 hours
• Half-Life: Approximately 12 hours
• Renal Elimination: Approximately 27%
• No Routine Coagulation Monitoring Required: Unlike warfarin, does not require regular INR testing

Benefits

• Superior Stroke Reduction: Demonstrated significantly greater efficacy in preventing stroke and systemic embolism compared to warfarin in clinical trials
• Reduced Major Bleeding Risk: Associated with significantly lower rates of intracranial hemorrhage and fatal bleeding compared to warfarin
• Predictable Pharmacokinetics: Provides consistent anticoagulation effect without dietary restrictions
• Fixed Dosing Regimen: Simplifies treatment administration without routine blood monitoring
• Rapid Onset and Offset: Allows for quick therapeutic effect and relatively short duration of action after discontinuation
• Comprehensive Protection: Effective for both stroke prevention in atrial fibrillation and treatment/prevention of venous thromboembolism

Common use

Eliquis is primarily indicated for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It is also approved for the prophylaxis of deep vein thrombosis (DVT) following hip or knee replacement surgery, for the treatment of DVT and pulmonary embolism (PE), and for the reduction in risk of recurrent DVT and PE following initial therapy. The medication is particularly valuable for patients who require long-term anticoagulation but seek an alternative to vitamin K antagonists with fewer monitoring requirements and food interactions.

Dosage and direction

For stroke reduction in nonvalvular atrial fibrillation: The recommended dose is 5 mg taken orally twice daily. For patients with at least two of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, the recommended dose is 2.5 mg twice daily. For DVT/PE treatment: 10 mg twice daily for 7 days, followed by 5 mg twice daily. For postoperative thromboprophylaxis: 2.5 mg twice daily for 35 days (hip replacement) or 12 days (knee replacement). Tablets should be swallowed whole with water, with or without food. Do not crush, split, or chew tablets.

Precautions

Patients should be carefully evaluated for bleeding risk before initiating therapy. Regular assessment of renal function is recommended, with dosage adjustment required for severe renal impairment (creatinine clearance 15-29 mL/min). Hepatic function should be monitored, as patients with severe hepatic impairment may have increased exposure to apixaban. Spinal/epidural hematoma may occur in patients receiving neuraxial anesthesia or spinal puncture; monitor frequently for neurological impairment. Patients should be advised about signs and symptoms of bleeding and instructed when to seek immediate medical attention.

Contraindications

Eliquis is contraindicated in patients with active pathological bleeding and in those with severe hypersensitivity reaction to apixaban. It should not be used in patients with triple-positive antiphospholipid syndrome due to increased thrombotic risk. Concomitant use with strong dual inhibitors of both CYP3A4 and P-glycoprotein (such as ketoconazole, itraconazole, ritonavir, or clarithromycin) is contraindicated. The medication is not recommended for patients with prosthetic heart valves or moderate to severe mitral stenosis.

Possible side effect

The most common adverse reaction is bleeding, which may manifest as:

• Major bleeding events requiring medical intervention
• Intracranial hemorrhage
• Gastrointestinal bleeding
• Hematuria
• Epistaxis
• Bruising and hematoma formation Non-hemorrhagic side effects may include:
• Nausea
• Anemia
• Rash
• Elevated liver enzymes
• Post-operative wound complications

Drug interaction

Eliquis has significant interactions with medications that affect CYP3A4 and P-glycoprotein pathways. Strong dual inhibitors of CYP3A4 and P-gp (ketoconazole, itraconazole, ritonavir) increase apixaban exposure and are contraindicated. Strong dual inducers (rifampin, carbamazepine, phenytoin) significantly decrease apixaban exposure. Concomitant use with other anticoagulants, antiplatelet agents, NSAIDs, and SSRIs increases bleeding risk. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors may enhance the bleeding risk. careful benefit-risk assessment is required when co-administering these medications.

Missed dose

If a dose of Eliquis is missed, the patient should take the dose as soon as possible on the same day and then resume the twice-daily regimen. Do not double the dose to make up for a missed dose. If a dose is skipped entirely, the patient should take the next dose at the regularly scheduled time. Maintaining the twice-daily schedule is crucial for consistent anticoagulation effect. Patients should be educated about the importance of adherence and provided with strategies to minimize missed doses.

Overdose

There is no specific antidote for apixaban overdose. Management of overdose should focus on supportive care and bleeding management. Activated charcoal may reduce absorption if administered within a few hours of ingestion. In cases of life-threatening bleeding, consider procoagulant agents such as prothrombin complex concentrate (PCC), activated prothrombin complex concentrate (aPCC), or recombinant factor VIIa, though their effectiveness has not been established in clinical trials. Tranexamic acid may be considered for adjunctive management. Dialysis is not expected to enhance elimination due to high protein binding.

Storage

Store Eliquis tablets at room temperature between 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original container with the lid tightly closed to protect from moisture and light. Keep out of reach of children and pets. Do not store in bathroom cabinets where moisture levels may fluctuate. Properly discard any unused medication after the expiration date or when no longer needed.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Eliquis is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual patient responses may vary, and treatment decisions should be based on comprehensive medical evaluation. Always consult with your healthcare provider before starting, stopping, or changing any medication regimen. Report any adverse effects to your physician immediately.

Reviews

Clinical trials demonstrate consistently positive outcomes with Eliquis. The ARISTOTLE trial showed a 21% reduction in stroke/systemic embolism and a 31% reduction in major bleeding compared to warfarin. Real-world evidence studies continue to support these findings, with particular emphasis on reduced intracranial hemorrhage rates. Patients frequently report satisfaction with the convenience of fixed dosing without routine monitoring. Healthcare providers appreciate the predictable pharmacokinetics and favorable risk-benefit profile. However, some patients note concerns about cost and the lack of a specific reversal agent, though recent approval of andexanet alfa has addressed this limitation.