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Eliquis (Apixaban): Uses, Dosing, Side Effects & Key Safety Info

Eliquis (apixaban) is a direct oral anticoagulant (DOAC) that selectively inhibits factor Xa, a key enzyme in the coagulation cascade. It's approved for multiple indications with predictable pharmacokinetics and no routine INR monitoring.

FDA-Approved Indications

  • Non-valvular atrial fibrillation: Reduce stroke/systemic embolism risk.
  • VTE treatment: DVT and PE treatment.
  • VTE recurrence prevention: After 6+ months initial treatment.
  • Post-operative VTE prophylaxis: Hip/knee replacement surgery.
  • Antiphospholipid syndrome (off-label but guideline-supported in select cases): With specialist oversight.

Standard Dosing

IndicationDose
NVAF5 mg twice daily (2.5 mg BID if ≥2 of: age ≥80, weight ≤60 kg, Scr ≥1.5 mg/dL)
VTE treatment10 mg BID × 7 days, then 5 mg BID
VTE prevention (recurrence)2.5 mg BID after initial treatment
Post-hip replacement2.5 mg BID × 35 days
Post-knee replacement2.5 mg BID × 12 days

Take with or without food. Do not double missed doses.

Common Side Effects (≥1%)

  • Bleeding: epistaxis, bruising, GI bleeding, hematuria, prolonged menses
  • Nausea, anemia, rash, elevated LFTs

Serious Risks

  • Major bleeding: Intracranial, GI, retroperitoneal. No specific reversal agent widely available (andexanet alfa approved but access limited).
  • Spinal/epidural hematoma: With neuraxial anesthesia—follow ASRA guidelines.
  • Hepatic impairment: Avoid in severe (Child-Pugh C).

Key Drug Interactions

  • Strong dual CYP3A4/P-gp inhibitors (ketoconazole, itraconazole, clarithromycin, ritonavir): ↑ apixaban → avoid or reduce dose.
  • Strong CYP3A4/P-gp inducers (rifampin, carbamazepine, phenytoin, St. John's wort): ↓ apixaban → avoid.
  • Other anticoagulants, antiplatelets, NSAIDs, SSRIs: Additive bleeding risk.

Contraindications & Precautions

  • Active pathological bleeding
  • Severe hepatic impairment
  • Hypersensitivity to apixaban
  • Pregnancy/breastfeeding: insufficient data—use only if benefit > risk
  • Mechanical heart valves: CONTRAINDICATED (RE-ALIGN trial showed harm)

Monitoring

  • Renal function (CrCl) periodically—dose adjustment if CrCl <15 or dialysis (limited data).
  • CBC, LFTs periodically.
  • No INR monitoring needed.

Eliquis is a cornerstone anticoagulant with favorable efficacy/safety vs. warfarin in major trials. Individualize therapy, review interactions at every visit, and educate patients on bleeding signs.

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