Eliquis (apixaban)

How does Eliquis Work?

Eliquis is taken orally and inhibits Factor Xa. Factor Xa is an enzyme that forms part of the body’s clotting system. It is the last enzyme in the clotting cascade and is responsible for creating the fibrin found in blood clots. Fibrin helps to keep newly formed clots stable. Eliquis inhibits the formation of fibrin, preventing the formation of blood clots.

Indications

Eliquis is indicated for:

Treatment of Deep Vein Thrombosis and/or the Treatment of Pulmonary Embolism

Eliquis is used in patients who have been diagnosed with a new clot in their veins (deep vein thrombosis). It is also used in patients with a lung clot (pulmonary embolism). It prevents clots from becoming more extensive and prevents a new clot from forming. It may be started as a first-line therapy in clinically stable patients and those with few blood clots. It is safe in patients who have active cancer and are receiving chemotherapy.

Prevention of Deep Vein Thrombosis

Patients having major joint replacement surgery (total hip replacement or total knee replacement) are at risk of developing blood clots. Eliquis is started 12 to 24 hours after surgery to prevent the formation of these clots.

Prevention of Systemic Embolism and Stroke in Patients with Atrial Fibrillation

Patients with atrial fibrillation risk having clots form in the heart. Eliquis is used to prevent these clots from forming in the heart.

Long Term Anticoagulation: Patients who have had a blood clot or a pulmonary embolism may require long-term anticoagulation (>6 months). Eliquis can be used in these cases to ensure adequate anticoagulation.

Dosage

Treatment of Deep Vein Thrombosis or the Treatment of Pulmonary Embolism:

In these cases, Eliquis is given as 10 mg twice a day for seven days and then 5 mg twice a day.

Prevention of Deep Vein Thrombosis:

In these cases, Eliquis is given as 2.5 mg twice a day, starting treatment 12 to 24 hours after surgery.

Prevention of Systemic Embolism and Stroke in Patients with Atrial Fibrillation:

In these cases, Eliquis is given 5 mg twice daily. Where patients have any two of the following risk factors (bodyweight 60 kg, age 80 years of age, or a serum creatinine 1.5 mg/dl), the dose is reduced to 2.5 mg daily.

Warnings & Precautions

Major bleeding

Eliquis increases the chance of having major bleeding that may, in some cases, be fatal. Risk factors for a major bleed include a history of stroke, gastrointestinal bleeding, prior bleeding, renal or liver impairment, older patients (>80 years of age), hypertension, alcohol use, diabetes, and malignancy. Of note, there is a high risk for spinal or epidural bleeding in patients who have neuraxial anesthesia or spinal puncture while being treated with Eliquis. Patients having surgery should inform their doctor that they are taking Eliquis.

Discontinuation

Stopping Eliquis prematurely increases the risk of developing clots. Only stop taking Eliquis under the guidance of a doctor. Consider using an alternative anticoagulant.

Antiphospholipid syndrome

Eliquis is not recommended for use in patients with antiphospholipid syndrome. Compared to a vitamin K antagonist anticoagulant such as warfarin, a higher incidence of thrombosis has been reported when using Eliquis.

Hepatic impairment

Take care when using Eliquis in patients with liver impairment. There is insufficient evidence to guide dosing accurately.

Renal impairment

Take care when using Eliquis in patients with renal impairment or with worsening renal function. There is insufficient evidence to guide dosing accurately. Dosing adjustments may be needed in patients with renal impairment.

Valvular heart disease

Eliquis should not be used in patients who require anticoagulation for mechanical heart valves.

Reversal of Eliquis

There is no specific way to reverse the effects of Eliquis. The effects will persist for approximately 24 hours after taking the last dose.

Special Populations

Acutely ill patients

Patients suffering from acute illness, such as respiratory failure or heart failure, are more likely to develop blood clots. Using Eliquis in these patients for an extended period (> 30 days) increases the risk of a bleeding complication without significantly decreasing the risk of developing a blood clot.

Elderly patients

The dose of Eliquis should be reduced in patients who are 80 years of age and have a serum creatinine level of 1.5 mg/dl or who weigh 60 kg.

Children

Eliquis has not been tested extensively in persons under 18 years of age. As a result, its use is not recommended in this age group.

Pregnancy

Eliquis has not been tested extensively in pregnant women. As a result, its use is not recommended during pregnancy. Should you fall pregnant while on Eliquis, contact your doctor as soon as possible.

Breastfeeding

The safety of Eliquis has not been tested in breastfeeding mothers. Taking Eliquis may affect your baby. If you wish to breastfeed, contact your doctor to discuss your options.

Side Effects

Common side effects of Eliquis include:

• Bleeding:
  • More bleeding than usual from minor cuts or scrapes
  • A tendency to bruise and swell more than usual after minor bumps
  • Nosebleeds
  • Bleeding from the gums
• Nausea
• Headache

Less common side effects (<1%) include:

• Bleeding:
  • Rectal bleeding
  • Excessive bleeding and bruising from wounds after injury or surgery
  • Eye bleeding (conjunctiva and retina)
  • Heavy menstrual bleeding
  • Urinary tract bleeding
  • Intracranial bleeding
• Increase in liver enzymes (serum alkaline phosphates, serum transaminases, increased serum bilirubin)
• Allergic angioedema
• Anaphylaxis

Drug Interactions

Certain drugs may interact with Eliquis to increase risk of bleeding. These include:

• antibiotics (e.g., fucidin, clarithromycin)
• anticoagulants (e.g., warfarin, dabigatran, rivaroxaban, heparin)
• antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• antiplatelet agents (e.g., aspirin, P2Y12 inhibitors)
• carbamazepine
• dexamethasone
• estrogens
• herbal products (e.g., alfalfa, anise, garlic, omega-3 fatty acids, grapefruit juice, ginger, ginseng)
• NSAIDs (e.g., naproxen, ibuprofen)
• prostacyclin
• SSRIs (e.g., citalopram, escitalopram, fluoxetine)
• thrombolytic agents (e.g., alteplase, streptokinase, urokinase)

Frequently Asked Questions