ELIQUIS (Apixaban) – Oral Anticoagulant for Stroke and Thrombosis Prevention

ELIQUIS is an oral anticoagulant medication that contains apixaban as its active ingredient. It is used to prevent blood clots in patients at risk of stroke or systemic embolism due to nonvalvular atrial fibrillation, and to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE), including following orthopedic surgery.

• Prevention of stroke and systemic embolism: For adults with nonvalvular atrial fibrillation.
• Prevention of deep vein thrombosis (DVT): In adults undergoing hip or knee replacement surgery to reduce risk of blood clots that may lead to pulmonary embolism (PE).
• Treatment of DVT and PE: Used in adults for initial and ongoing treatment of DVT and PE.
• Reduction of recurrence: To lower the risk of recurrent DVT and PE following at least 6 months of initial therapy.

Apixaban

ELIQUIS works by selectively inhibiting factor Xa, an essential enzyme in the coagulation cascade responsible for blood clot formation. By blocking factor Xa, ELIQUIS reduces the generation of thrombin and thus prevents the formation and growth of blood clots.

Stroke and systemic embolism prevention in nonvalvular atrial fibrillation:

• 5 mg orally twice daily for most patients.
• 2.5 mg orally twice daily for patients with at least two of the following: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.

Prophylaxis of DVT following hip or knee replacement surgery:

• 2.5 mg orally twice daily, starting 12 to 24 hours after surgery.
• Treatment duration: 35 days for hip replacement; 12 days for knee replacement.

Treatment of DVT and PE:

• 10 mg orally twice daily for the first 7 days.
• Followed by 5 mg orally twice daily thereafter.

Reduction in risk of recurrent DVT and PE:

• 2.5 mg orally twice daily after at least 6 months of initial treatment.

Additional instructions:

• If a dose is missed, take it as soon as possible on the same day; do not double dose.
• Stop ELIQUIS at least 48 hours before elective surgery or procedures with moderate/high bleeding risk; at least 24 hours before procedures with low bleeding risk.
• When switching from warfarin to ELIQUIS, start ELIQUIS when INR is below 2.0.
• For patients receiving 5 mg or 10 mg twice daily, reduce dose by 50% when coadministered with combined P-glycoprotein and strong CYP3A4 inhibitors.
• Tablets can be crushed and suspended in water, D5W, apple juice, or mixed with applesauce for oral or nasogastric administration.

• Active pathological bleeding.
• Severe hypersensitivity reactions to apixaban (e.g., anaphylaxis).

Risks associated with ELIQUIS:

• Premature discontinuation: Stopping ELIQUIS without adequate alternative anticoagulation increases risk of thrombotic events, including stroke.
• Bleeding: ELIQUIS can cause serious and potentially fatal bleeding. Monitor carefully for signs of blood loss and discontinue if active pathological bleeding occurs.
• Spinal/epidural hematoma: Risk of epidural or spinal hematomas, which may cause permanent paralysis, is increased with neuraxial anesthesia or spinal puncture. Use caution and monitor neurological status.
• Prosthetic heart valves: Use of ELIQUIS is not recommended in patients with prosthetic heart valves.
• Triple positive antiphospholipid syndrome: ELIQUIS is not recommended due to increased recurrent thrombotic risk compared to vitamin K antagonists.
• Surgery: Discontinue ELIQUIS prior to elective surgeries according to bleeding risk; bridging anticoagulation usually not needed.

The most common adverse reactions relate to bleeding events (greater than 1%). Serious bleeding, including major and fatal bleeding, can occur. Patients should be monitored for any signs of excessive bleeding.

• Coadministration with combined P-glycoprotein (P-gp) and strong cytochrome P450 3A4 (CYP3A4) inhibitors (e.g., ketoconazole, itraconazole, ritonavir) requires dose reduction by 50% for patients on 5 mg or 10 mg twice daily dosing. Avoid in patients on 2.5 mg twice daily.
• Concurrent use with other agents affecting hemostasis, such as aspirin, other antiplatelets, anticoagulants, heparin, thrombolytics, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and NSAIDs, increases bleeding risk.

Pregnancy and lactation guidance not provided in the supplied evidence.

Overdose may result in bleeding. Activated charcoal can reduce absorption if given shortly after ingestion. Hemodialysis is unlikely to remove apixaban significantly. Specific reversal agents targeting anti-factor Xa activity are available. Prothrombin complex concentrates or recombinant factor VIIa may be considered but are not formally evaluated.

No specific storage conditions detailed in the provided evidence.