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. As a direct Factor Xa inhibitor, it represents a significant advancement in thromboembolic risk management, offering predictable pharmacokinetics and a favorable safety profile compared to traditional vitamin K antagonists. Its targeted mechanism provides effective anticoagulation while minimizing many limitations associated with older therapies, making it a cornerstone medication in cardiovascular protection strategies.

Features

• Contains apixaban as the active pharmaceutical ingredient
• Available in 2.5 mg and 5 mg film-coated tablets
• Direct Factor Xa inhibitor with high selectivity
• Rapid onset of action with peak plasma concentrations within 3-4 hours
• Dual elimination pathway (approximately 25% renal, 75% hepatic/biliary)
• Does not require routine coagulation monitoring
• Fixed dosing regimen without dietary restrictions

Benefits

• Superior stroke reduction demonstrated in large-scale clinical trials compared to warfarin
• Significantly lower risk of major bleeding particularly intracranial hemorrhage
• No routine INR monitoring required, reducing treatment burden and healthcare visits
• Minimal food and drug interactions compared to vitamin K antagonists
• Predictable anticoagulant effect without the genetic variability issues seen with warfarin
• Convenient twice-daily dosing supporting medication adherence

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, and for the treatment of DVT and pulmonary embolism (PE), including extended therapy to reduce the risk of recurrent DVT and PE. The medication is particularly valuable for patients who require long-term anticoagulation but seek to avoid the monitoring requirements and dietary restrictions associated with warfarin 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 DVT/PE treatment: 10 mg twice daily for 7 days, followed by 5 mg twice daily. For extended treatment: 2.5 mg twice daily after at least 6 months of standard therapy.

For postoperative thromboprophylaxis: 2.5 mg twice daily, initiated 12-24 hours post-surgery.

Tablets should be swallowed whole with water, with or without food. Consistency in administration timing is recommended to maintain steady anticoagulant effects.

Precautions

Regular assessment of renal function is recommended, particularly in elderly patients or those with comorbid conditions. Hepatic function should be monitored in patients with hepatic impairment. Patients should be carefully evaluated for bleeding risk factors before initiation. Special caution is required in patients with prosthetic heart valves or hemodynamically significant rheumatic heart disease, as Eliquis is not recommended for these conditions. Dental procedures and other interventions should be carefully managed with appropriate bleeding precautions.

Contraindications

Active pathological bleeding, severe hypersensitivity reaction to apixaban or any component of the formulation, and patients with triple-positive antiphospholipid syndrome due to increased thrombotic risk. Not recommended for patients with mechanical prosthetic heart valves or moderate-to-severe mitral stenosis.

Possible side effects

• Common: Bruising, epistaxis, gastrointestinal bleeding, hematuria
• Serious: Intracranial hemorrhage, spinal/epidural hematoma (particularly with neuraxial anesthesia)
• Other: Hypersensitivity reactions, skin rash, elevated liver enzymes
• Rare: Thrombocytopenia, jaundice

The incidence of major bleeding is generally lower than with warfarin, but any signs of bleeding should be promptly evaluated.

Drug interaction

Strong dual inhibitors of CYP3A4 and P-glycoprotein (such as ketoconazole, itraconazole, ritonavir) significantly increase apixaban exposure and are contraindicated. Strong dual inducers of CYP3A4 and P-glycoprotein (such as rifampin, carbamazepine, St. John’s wort) significantly decrease apixaban exposure and should be avoided. Anticoagulants, antiplatelet agents, and NSAIDs increase bleeding risk. Careful consideration is needed when co-administering with other drugs affecting hemostasis.

Missed dose

If a dose is missed, the patient should take it as soon as possible on the same day and resume the twice-daily schedule. The dose should not be doubled to make up for a missed dose. Maintaining the regular dosing schedule is important for consistent anticoagulant protection.

Overdose

Overdose may lead to hemorrhagic complications. There is no specific antidote for apixaban overdose. Management includes discontinuation of Eliquis, symptomatic treatment, and supportive care. Activated charcoal may reduce absorption if administered shortly after ingestion. In cases of life-threatening bleeding, procoagulant agents such as prothrombin complex concentrate may be considered, though their effectiveness has not been fully established in clinical studies.

Storage

Store at room temperature (20-25°C/68-77°F) with excursions permitted between 15-30°C (59-86°F). Keep in the original container with the lid tightly closed to protect from moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made in consultation with a qualified healthcare professional based on individual patient characteristics and needs. The prescribing physician should be familiar with the complete prescribing information and latest clinical guidelines for anticoagulant therapy.

Reviews

Clinical trials demonstrate Eliquis’ superior efficacy and safety profile. The ARISTOTLE trial showed a 21% reduction in stroke/systemic embolism and a 31% reduction in major bleeding compared to warfarin. The AVERROES trial showed significant superiority over aspirin in patients unsuitable for warfarin therapy. Real-world evidence continues to support these findings, with studies showing consistent effectiveness in diverse patient populations. Healthcare providers consistently report high satisfaction with its predictable pharmacokinetics and reduced monitoring requirements.