Eliquis: Advanced Anticoagulation for Stroke Prevention in Atrial Fibrillation
Eliquis
| Product dosage: 2.5mg | |||
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| Product dosage: 5mg | |||
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| 60 | $5.33
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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 non-valvular atrial fibrillation. As a direct Factor Xa inhibitor, it offers a targeted mechanism of action that provides predictable anticoagulation without the need for routine coagulation monitoring. Its clinical profile is supported by extensive trial data demonstrating superior efficacy and a favorable safety margin compared to warfarin in appropriate patient populations. This medication represents a significant advancement in thromboprophylaxis, balancing potent anticoagulation with manageable bleeding risks.
Features
- Active pharmaceutical ingredient: Apixaban
- Pharmacologic class: Direct Factor Xa inhibitor
- Standard dosage forms: 2.5 mg and 5 mg film-coated tablets
- Rapid onset of action: Peak plasma concentrations within 3-4 hours
- Dual elimination pathway: Approximately 25% renal excretion, remainder fecal
- Half-life: Approximately 12 hours
- No requirement for routine INR monitoring
- Fixed dosing regimen based on specific patient criteria
Benefits
- Superior stroke reduction: Demonstrated significantly lower rates of ischemic and hemorrhagic stroke compared to warfarin in clinical trials
- Reduced major bleeding risk: Features a 31% lower incidence of major bleeding events versus warfarin
- Predictable anticoagulant effect: Provides consistent blood thinning without dietary vitamin K interactions
- Convenient dosing regimen: Twice-daily administration without routine blood test requirements
- Comprehensive protection: Effective for both stroke prevention and treatment/ prevention of venous thromboembolism
- Flexible transition protocols: Well-established guidelines for switching from other anticoagulants
Common use
Eliquis is primarily indicated for reducing 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) 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 alternatives to warfarin therapy.
Dosage and direction
For stroke prevention 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 postoperative thromboprophylaxis: 2.5 mg twice daily initiated 12-24 hours post surgery. For DVT/PE treatment: 10 mg twice daily for 7 days, followed by 5 mg twice daily. Tablets should be swallowed whole with water, with or without food. Consistency in administration timing is recommended to maintain steady-state concentrations.
Precautions
Regular assessment of renal function is recommended, particularly in elderly patients or those with declining renal function. Hepatic function should be monitored in patients with moderate hepatic impairment (Child-Pugh B); use is not recommended in severe hepatic impairment. Patients should be carefully evaluated for bleeding risk factors before initiation. Special caution is required in patients with congenital or acquired bleeding disorders, active ulcerative gastrointestinal disease, and recent biopsy or major trauma. Concomitant use with other anticoagulants or antiplatelet agents increases bleeding risk and requires careful consideration.
Contraindications
Eliquis is contraindicated in patients with active pathological bleeding, severe hypersensitivity reaction to apixaban, and patients with artificial heart valves (mechanical prosthetic valves). 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 due to significantly increased apixaban exposure.
Possible side effects
The most common adverse reactions include:
- Bleeding events (ranging from minor bruising to major hemorrhage)
- Nausea
- Anemia
- Rash
- Elevated liver enzymes (transaminases)
- Post-operative wound complications
- Hypersensitivity reactions (including anaphylaxis in rare cases)
- Thrombocytopenia (rare)
Serious side effects requiring immediate medical attention include signs of bleeding (unusual bruising, bleeding that won’t stop, pink or brown urine, red or black stools, coughing up blood, vomiting blood or coffee-ground material), signs of stroke (sudden numbness or weakness, confusion, vision problems, dizziness, severe headache), and allergic reactions (hives, difficulty breathing, swelling of face or throat).
Drug interaction
Eliquis interacts significantly with:
- Strong dual inhibitors of CYP3A4 and P-gp: Increase apixaban exposure approximately 2-fold (contraindicated)
- Strong dual inducers of CYP3A4 and P-gp: Decrease apixaban exposure approximately 50% (avoid coadministration)
- Anticoagulants (warfarin, heparin, enoxaparin): Increased bleeding risk
- Antiplatelet agents (aspirin, clopidogrel, NSAIDs): Increased bleeding risk
- Selective serotonin reuptake inhibitors/serotonin norepinephrine reuptake inhibitors: May increase bleeding risk
- St. John’s Wort: Significantly decreases apixaban efficacy
Missed dose
If a dose of Eliquis is missed, the patient should take it as soon as possible on the same day and then resume the twice-daily regimen. The dose should not be doubled to make up for a missed dose. If the missed dose is not remembered until the next scheduled dose is due, only one dose should be taken. Maintaining the twice-daily schedule is crucial for maintaining therapeutic anticoagulation levels.
Overdose
There is no specific antidote for apixaban overdose. Management of overdose should focus on supportive care and management of bleeding events. In cases of life-threatening bleeding, consider the following approaches: administration of activated charcoal if ingestion was recent, symptomatic treatment of bleeding, fluid replacement, hemodynamic support, and blood product transfusion as clinically indicated. Prothrombin complex concentrate, activated prothrombin complex concentrate, or recombinant Factor VIIa may be considered, though their effectiveness has not been established in clinical studies. Dialysis is not expected to enhance apixaban 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. Do not transfer to other containers. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Protect from excessive heat and moisture.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by qualified healthcare professionals based on individual patient circumstances. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions. Patients should consult with their healthcare provider for complete information about their medication regimen and report any side effects to their physician promptly.
Reviews
Clinical trials demonstrate Eliquis’s favorable profile among direct oral anticoagulants. The ARISTOTLE trial showed apixaban was superior to warfarin in preventing stroke or systemic embolism with significantly less bleeding and lower mortality. Real-world evidence studies consistently show better effectiveness and safety outcomes compared to other anticoagulants. Patients report high satisfaction with the convenience of fixed dosing without monitoring requirements. Healthcare providers appreciate the predictable pharmacokinetics and reduced drug-drug interaction profile compared to some other agents in its class. The medication maintains high adherence rates due to its twice-daily dosing schedule and favorable side effect profile.