Apixaban (Eliquis®): A Deep Dive

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What is it?

Apixaban, also known as Eliquis®, is a prescribed anticoagulant medication (sometimes called a blood thinner). It’s part of a class of medications called direct oral anticoagulants (DOACs).

Apixaban is used to treat blood clots (or prevent new ones from forming) in patients with:

How does it work?

Apixaban prevents clots from forming by directly blocking factor Xa in the clotting cascade. “The clotting cascade is how your body forms clots and can be both good and bad. In cases of NVAF or venous thromboembolism (VTE or blood clots), we want to limit the body’s ability to form dangerous clots,” explains Dr. Christian Ruff, Director of General Cardiology at Brigham and Women’s Hospital in Boston, MA and President of the NATF Medical Advisory Board.

Apixaban is prescribed as either a 5-mg or 2.5-mg tablet and should be taken twice daily with or without food.

What are the benefits of taking apixaban?

  • Apixaban is just as effective than warfarin in lowering the risk of stroke in patients with NVAF – and in preventing recurrent blood clots in patients with DVT or PE. 
  • Apixaban has also been shown in clinical trials to cause less major bleeding in patients compared to warfarin.
  • Apixaban doesn’t require routine blood tests or dietary restrictions.

What are the risks associated with apixaban?

  • Bleeding is the biggest risk associated with apixaban. Patients must be mindful about avoiding injuries, such as head injuries that may cause major bleeding. 
    • “Patients who are at risk for head injury, such as those who play sports, really need to be careful when it comes to their bleeding risk,” says John Fanikos, RPh, MBA, Director of Pharmacy Services for Brigham and Women’s Hospital.
  • Outside of major bleeds, patients may also experience gum bleeds, nosebleeds, increased bruising, bleeding around the eyes (very rare), and other forms of minor bleeding. 
    • However, in the event of major or life-threatening bleeding, apixaban can be reversed with a medication called andexanet alfa (Andexxa®).

Safety considerations

If you’re on apixaban, you can help further manage your bleeding risk by: 

  • Taking your medicine as directed. You should never stop your medication or change your dosage without talking to your healthcare provider first. 
  • Telling your healthcare providers about all medicines or supplements that you take—including over-the-counter medications, natural products, and vitamins—to avoid drug interactions. 
  • Avoiding certain anti-infectives (antibiotics and/or antiviral/antifungal medications, other blood thinners (heparin, warfarin), aspirin, ibuprofen, and some seizure medications or antidepressants, unless recommended by your healthcare provider.
  • Limiting or avoiding alcohol use.
  • Making sure to talk to your healthcare provider before having any type of surgical procedure.

Pregnancy or breastfeeding considerations

Apixaban is unsafe to use in pregnancy and is also not recommended for use in patients who are breastfeeding.

For more information about apixaban, please see our Anticoagulant Comparison Chart!

References

FDA Prescribing Information. 2011. 

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