Eliquis: Advanced Anticoagulation for Stroke Prevention in Atrial Fibrillation
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| Product dosage: 5mg | |||
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Synonyms | |||
Eliquis (apixaban) is a next-generation oral anticoagulant specifically engineered to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It represents a significant advancement in anticoagulation therapy, offering a targeted mechanism of action that directly inhibits Factor Xa, a key component in the blood coagulation cascade. Its predictable pharmacokinetic profile allows for fixed dosing without the need for routine coagulation monitoring, streamlining long-term management for appropriate patients. This medication is prescribed when an effective, well-tolerated alternative to traditional anticoagulants is clinically indicated.
Features
- Active pharmaceutical ingredient: Apixaban
- Pharmacologic class: Direct oral anticoagulant (DOAC), Factor Xa inhibitor
- Available strengths: 2.5 mg and 5 mg film-coated tablets
- Administration: Oral, with or without food
- Dosing frequency: Twice daily
- No requirement for routine international normalized ratio (INR) monitoring
- Rapid onset of action; peak plasma concentrations reached within 3–4 hours
- Half-life of approximately 12 hours in healthy subjects
Benefits
- Superior Stroke Risk Reduction: Demonstrated significant reduction in the risk of stroke and systemic embolism compared to warfarin in major clinical trials, with a lower rate of hemorrhagic stroke.
- Favorable Safety Profile: Associated with significantly lower rates of major bleeding, particularly intracranial hemorrhage, when compared to warfarin.
- Fixed Dosing Convenience: Eliminates the need for frequent blood draws and dose adjustments, enhancing adherence and reducing clinical burden.
- Minimal Food and Drug Interactions: Has fewer dietary restrictions and predictable pharmacokinetics, unlike vitamin K antagonists.
- Rapid Onset and Offset: Provides effective anticoagulation without the need for bridging therapy with parenteral agents in most scenarios.
- Renal Excretion Profile: Only ~25% renally excreted, making it a suitable option for patients with mild to moderate renal impairment (with dose adjustment).
Common use
Eliquis is primarily indicated to reduce 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), 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
For stroke reduction in 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 post-operative DVT prophylaxis following hip or knee replacement: 2.5 mg twice daily, initiated 12–24 hours post-surgery. For treatment of DVT/PE and reduction in risk of recurrence: 10 mg twice daily for 7 days, followed by 5 mg twice daily. Tablets should be swallowed whole with water, and may be taken with or without food. Adherence to the twice-daily schedule is critical for maintaining therapeutic anticoagulation.
Precautions
Patients should be advised that they may bruise more easily and it may take longer than usual for bleeding to stop. They should be vigilant for signs of bleeding or unusual bruising and report these to their physician immediately. Eliquis is not recommended in patients with prosthetic heart valves or in those with atrial fibrillation related to valvular disease (e.g., mitral stenosis). Use with caution in patients with severe renal impairment (CrCl 15-29 mL/min); it is not recommended in patients with CrCl <15 mL/min or on dialysis. Spinal or epidural hematomas can occur in patients treated with Eliquis who are receiving neuraxial anesthesia or undergoing spinal puncture; this can result in long-term or permanent paralysis.
Contraindications
Eliquis is contraindicated in patients with active pathological bleeding and in those with severe hypersensitivity reaction to apixaban (e.g., anaphylactic reactions). It must not be used in patients with triple-positive antiphospholipid syndrome due to increased risk of recurrent thrombotic events.
Possible side effect
The most common side effect is bleeding, which can range from minor (e.g., epistaxis, gingival bleeding, bruising) to major and life-threatening (e.g., gastrointestinal bleeding, intracranial hemorrhage). Other reported side effects include nausea, anemia, rash, and elevated liver enzymes (transaminases). Serious but rare side effects include hypersensitivity reactions and thrombocytopenia.
Drug interaction
Strong dual inhibitors of both CYP3A4 and P-glycoprotein (e.g., ketoconazole, itraconazole, ritonavir) significantly increase apixaban exposure and are contraindicated. Strong dual inducers of CYP3A4 and P-glycoprotein (e.g., rifampin, carbamazepine, St. John’s Wort) can decrease apixaban exposure and should be avoided. Concomitant use with other anticoagulants, antiplatelet agents, NSAIDs, and SSRIs increases the risk of bleeding. Careful consideration of benefit versus risk is required.
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. Administration should then resume with the next scheduled dose, maintaining the twice-daily regimen.
Overdose
Overdose may lead to hemorrhagic complications. There is no specific antidote; management consists of discontinuation of Eliquis and prompt supportive care focused on the bleeding site. Activated charcoal may reduce absorption if administered shortly after ingestion. In life-threatening bleeding, consider procoagulant agents such as prothrombin complex concentrate (PCC), activated PCC, or recombinant Factor VIIa, though their effectiveness has not been evaluated in clinical trials. Protamine sulfate and vitamin K are not expected to affect anticoagulation.
Storage
Store at room temperature between 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original bottle to protect from moisture and light. Keep out of reach of children and pets.
Disclaimer
This information is for educational purposes 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 any new treatment. Do not disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
“In my cardiology practice, Eliquis has become a first-line agent for stroke prevention in NVAF. The consistent efficacy and markedly lower incidence of intracranial hemorrhage compared to warfarin have significantly improved patient outcomes and simplified management.” – Cardiologist, 12 years experience “As a pharmacist, I appreciate the fixed dosing and lack of routine monitoring. It improves adherence and reduces clinic visits, though patient education on bleeding signs remains paramount.” – Clinical Pharmacist, Board Certified “After switching from warfarin, the freedom from dietary restrictions and frequent blood tests has greatly improved my quality of life. I haven’t experienced any significant side effects.” – Patient, 68 years old “The ARISTOTLE trial data is compelling. The reduction in stroke and major bleeding provides a strong evidence base for its use. It is a cornerstone of modern anticoagulation therapy.” – Vascular Neurologist, Researcher “Post-hip replacement, the regimen was straightforward. No injections, just a simple pill. I experienced no complications during recovery.” – Patient, 71 years old