In this edition of our Guidelines+ Monographs Series, we will be taking a look at Bristol-Myers Squibb’s medication apixaban, brand name Eliquis. Initially approved in 2012, Eliquis is a factor Xa inhibitor, an anticoagulant used to prevent stroke and systemic embolism in nonvalvular atrial fibrillation, and to treat deep vein thrombosis (DVT) and pulmonary embolism (PE).
This Guidelines+ Monograph will take a deeper dive into apixaban, as well as outline the current clinical practice guidelines featuring the medication. Please note that this Guidelines+ Monograph for apixaban is current as of July 2024. Consult our clinical guidelines library and/or or medication information look up tool to ensure you are always accessing the most current information.
Without further delay, let’s jump in!
Medication Overview:
- Brand name: Eliquis
- Generic name: apixaban
- Manufacturer(s): Bristol-Myers Squibb
- Initial FDA Approval: December 2012
Indications and FDA Approval Details
| Indicated Condition | Indicated For | Age | Date Approved |
|---|---|---|---|
| Nonvalvular atrial fibrillation | The reduction of risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. | Adult | December 2012 |
| Patients who have undergone hip or knee replacement surgery | For the prophylaxis of DVT, which may lead to PE | Adult | March 2014 |
| Treatment of DVT and PE | For the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following initial therapy | Adult | August 2014 |
Dosage Forms and Strengths
| Dosage Form | Strength |
|---|---|
| Round tablet, with a pale yellow color | 2.5 mg |
| Oval tablet, with a pale orange or pink color | 5 mg |
Warnings and Precautions
- ELIQUIS can cause serious, potentially fatal, bleeding. Promptly evaluate signs and symptoms of blood loss. An agent to reverse the anti-factor Xa activity of apixaban is available.
- Prosthetic heart valves: ELIQUIS use not recommended.
- Increased Risk of Thrombosis in Patients with Triple Positive Antiphospholipid Syndrome: ELIQUIS use not recommended.
Adverse Reactions
Most common adverse reactions:
- Increased Risk of Thrombotic Events After Premature Discontinuation
- Bleeding
- Spinal/Epidural Anesthesia or Puncture
Now that we’ve covered the basic monograph information for apixaban, let’s take a closer look at how Eliquis is currently recommended in various clinical practice guidelines. We will categorize the list based on year, and then provide a general summary table at the end.
Specific Inclusions of Apixaban in Clinical Guidelines
- Anticoagulation for Stroke Prevention in Atrial Fibrillation and Treatment of Venous Thromboembolism and Portal Vein Thrombosis in Cirrhosis
- Authoring Society: International Society on Thrombosis and Haemostasis (ISTH)
- Publication Date: May 2024
- Apixaban-Related Recommendation(s): They recommend the use of either DOAC (including apixaban) or LMWH with/without VKA for patients with Child–Pugh A or B cirrhosis.
- Management of Patients with Atrial Fibrillation
- Authoring Society: American College of Cardiology, American Heart Association, Heart Rhythm Society, American College of Clinical Pharmacy (ACC/AHA/HRS/ACCP)
- Publication Date: November 2023
- Apixaban-Related Recommendation(s): DOAC’s including apixaban are currently recommended as the first-line therapy over warfarin in patients with AF (except moderate to severe mitral stenosis or mechanical heart valve recipients) in this guideline.
- Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer
- Authoring Society: American Society of Clinical Oncology (ASCO)
- Publication Date: April 2023
- Apixaban-Related Recommendation(s): Apixaban was added as an option for extended pharmacologic thromboprophylaxis after cancer surgery, with a weak strength of recommendation. Apixaban was also added as an option for the treatment of VTE, with high quality of evidence and a strong recommendation.
- Treatment and Prophylaxis of Venous Thromboembolism in Patients with Cancer Including Patients with COVID-19
- Authoring Society: International Initiative on Thrombosis and Cancer (IITC)
- Publication Date: July 2022
- Apixaban-Related Recommendation(s): For patients who do not have a high risk of gastrointestinal or genitourinary bleeding, rivaroxaban or apixaban (in the first 10 days), or edoxaban (started after at least 5 days of parenteral anticoagulation) can also be used for the initial treatment of established VTE in patients with cancer when creatinine clearance is ≥30 mL/min (grade 1A). Direct oral anticoagulants (edoxaban, rivaroxaban, or apixaban) are recommended for patients with cancer when creatinine clearance is ≥30 mL/min in the absence of strong drug–drug interactions or gastrointestinal absorption impairment (grade 1A). The recommendation for direct oral anticoagulants, including apixaban, is upgraded from 1B to 1A.
- Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism
- Authoring Society: American Society of Hematology (ASH)
- Publication Date: October 2020
- Apixaban-Related Recommendation(s): Apixaban is recommended for the treatment of acute DVT and PE.
- Antithrombotic Therapy for Atrial Fibrillation
- Authoring Society: American College of Chest Physicians (CHEST)
- Publication Date: August 2018
- Apixaban-Related Recommendation(s): Apixaban is recommended as one of the preferred oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation.
- Pharmacologic Management of Newly Detected Atrial Fibrillation
- Authoring Society: American Academy of Family Physicians (AAFP)
- Publication Date: April 2017
- Apixaban-Related Recommendation(s): “The AAFP strongly recommends that patients who have atrial fibrillation receive chronic anticoagulation unless they are at low risk of stroke (CHADS2<2) or have specific contraindications (strong recommendation, high-quality evidence). Choice of anticoagulation therapy should be based on patient preferences and patient history. Options for anticoagulation therapy may include warfarin, apixaban, dabigatran, edoxaban, or rivaroxaban.
Summary Table Apixaban in Clinical Guidelines
| Topic | Society | Title | Pub Date | Apixaban Included? | Recs |
|---|---|---|---|---|---|
| Atrial Fibrillation, DVT/PE | ISTH | Anticoagulation for Stroke Prevention in Atrial Fibrillation and Treatment of Venous Thromboembolism and Portal Vein Thrombosis in Cirrhosis | May 2024 | Yes | They suggest the use of either DOAC (including apixaban) or LMWH with/without VKA for patients with Child–Pugh A or B cirrhosis |
| Atrial Fibrillation | ACC/AHA, ACCP/HRS | Management of Patients with Atrial Fibrillation | November 2023 | Yes | DOAC’s including apixaban are currently recommended as the first-line therapy over warfarin in patients with AF (exceptmoderate to severe mitral stenosis or mechanical heartvalve recipients) in this guideline. |
| DVT | ASCO | Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer | April 2023 | Yes | Apixaban was added as an option for extended pharmacologic thromboprophylaxis after cancer surgery, with a weak strength of recommendation. Apixaban was also added as an option for the treatment of VTE, with high quality of evidence and a strong recommendation. |
| DVT | ITAC | Treatment and Prophylaxis of Venous Thromboembolism in Patients with Cancer Including Patients with COVID-19 | July 2022 | Yes | For patients who do not have a high risk of gastrointestinal or genitourinary bleeding, rivaroxaban or apixaban (in the first 10 days), or edoxaban (started after at least 5 days of parenteral anticoagulation) can also be used for the initial treatment of established VTE in patients with cancer when creatinine clearance is ≥30 mL/min (grade 1A). |
| DVT/PE | ASH | Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism | October 2020 | Yes | Apixaban is recommended for the treatment of acute DVT and PE. |
| Atrial Fibrillation | CHEST | Antithrombotic Therapy for Atrial Fibrillation | August 2018 | Yes | Apixaban is recommended as one of the preferred oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation |
| Atrial Fibrillation | AAFP | Pharmacologic Management of Newly Detected Atrial Fibrillation | April 2017 | Yes | The AAFP strongly recommends that patients who have atrial fibrillation receive chronic anticoagulation unless they are at low risk of stroke (CHADS2 <2) or have specific contraindications (strong recommendation, high-quality evidence).. |
This concludes our Guidelines+ Monographs for Apixaban (Eliquis). This list is current as of July 2024 and may be updated over time as new indications are approved and/or new guidelines published or updated. Sign up for alerts and stay informed on the latest published guidelines and articles.
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