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Apixaban

(Eliquis®)

Apixaban

Drug updated on 4/15/2024

Dosage FormTablet (oral; 2.5 mg, 5 mg)
Drug ClassFactor Xa inhibitors
Ongoing and
Completed Studies		ClinicalTrials.gov

Indication

  • Indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
  • Indicated for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery.
  • Indicated for the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following initial therapy.

Summary
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  • Apixaban (Eliquis) is indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, for prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients undergoing hip or knee replacement surgery, and for the treatment of DVT and PE.
  • A total of 51 systematic reviews/meta-analyses evaluated the safety and efficacy of apixaban compared to other anticoagulants.
  • In COVID-19 patients, apixaban did not significantly reduce mortality or thromboembolic events compared to placebo, indicating a need for further research on its risk-benefit profile in this subgroup.
  • Following hip or knee replacement surgery, apixaban showed an optimal balance between venous thromboembolism prevention and hemorrhage control, suggesting it has a favorable profile for prophylaxis in these surgical patients.
  • For end-stage renal disease (ESRD) patients undergoing dialysis with atrial fibrillation, no statistically significant reduction was observed in mortality rates or in the prevention against ischemic/hemorrhagic strokes using apixaban, suggesting more precise clinical protocols are needed.
  • Intravenous thrombolysis was not associated with increased symptomatic intracranial hemorrhage risks among direct oral anticoagulant users, including those taking apixaban, suggesting its safe use during acute ischemic stroke situations.
  • In electrical cardioversion procedures involving atrial fibrillation patient groups, direct oral anticoagulants like apixaban provided similar protection against potential blood clots while having a lower major bleeding incidence than vitamin K antagonists, making them safer alternatives.
  • Apixaban demonstrated superior performance over warfarin by reducing venous thromboembolism recurrence as well as major bleeding incidents among severe renal failure/chronic kidney disease sufferers, highlighting both its effectiveness and safety within this particular group.
  • The drug also proved effective and safe in treating cerebral venous thrombosis (CVT), suggesting potential for broader use in this rare condition.
  • Compared to other direct oral anticoagulants like dabigatran, rivaroxaban, and edoxaban, apixaban often had a lower risk of bleeding while effectively reducing thromboembolic events across several patient subgroups.

Product Monograph / Prescribing Information

Document TitleYearSource
Eliquis (apixaban) Prescribing Information.2021Bristol-Myers Squibb Company., Princeton, NJ

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Safety and efficacy of antithrombotics in outpatients with symptomatic COVID-19: a systematic review and meta-analysis.2024Current Problems in Cardiology
Antithrombotic prophylaxis following total hip arthroplasty: a level I Bayesian network meta-analysis.2024Journal of Orthopaedics and Traumatology
Anticoagulant drugs for patients with atrial fibrillation on dialysis: a systematic analysis and network meta-analysis.2023Frontiers in Pharmacology
Meta-analysis of outcomes following intravenous thrombolysis in patients with ischemic stroke on direct oral anticoagulants.2023BMC Neurology
Safety and efficacy of direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation electrical cardioversion: An update systematic review and meta-analysis.2023International Journal of Cardiology
Safety and efficacy of apixaban versus low-molecular weight heparin or vitamin-K antagonists for venous thromboembolism treatment in patients with severe renal failure: A systematic review and meta-analysis.2023Thrombosis Research
Apixaban for the treatment of cerebral venous sinus thrombosis: a single-centre experience and systematic review of the literature.2023CNS Drugs
An evidence-based approach to anticoagulation therapy comparing direct oral anticoagulants and vitamin k antagonists in patients with atrial fibrillation and bioprosthetic valves: a systematic review, meta-analysis, and network meta-analysis.2023The American Journal of Cardiology
Efficacy and safety of apixaban versus dalteparin as a treatment for cancer-associated venous thromboembolism: a systematic review and meta-analysis. 2023Medicina (Kaunas)
Direct oral anticoagulants compared with other strategies in patients with atrial fibrillation and stroke or transient ischemic attack: Systematic review. 2023Journal of Formosan Association
Efficacy and safety of direct oral anticoagulants for stroke prevention in older patients with atrial fibrillation: a network meta-analysis of randomized controlled trials.2023Journal of the American Heart Association
Efficacy and safety of rivaroxaban versus apixaban for venous thromboembolism: a systematic review and meta-analysis of observational studies.2023Journal of Thrombosis and Thrombolysis
Meta-analysis comparing apixaban versus rivaroxaban for management of patients with nonvalvular atrial fibrillation. 2022The American Journal of Cardiology
Real-world evidence comparing oral anticoagulants in non-valvular atrial fibrillation: a systematic review and network meta-analysis. 2022Future Cardiology
Editor’s Choice – severe bleeding risks of direct oral anticoagulants in the prevention and treatment of venous thromboembolism: a network meta-analysis of randomised controlled trials. 2022European Journal of Vascular & Endovascular Surgery
Direct oral anticoagulants compared with dalteparin for treatment of cancer-associated thrombosis: a living, interactive systematic review and network meta-analysis.2022Mayo Clinic Proceedings
Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants: A meta-analysis and systematic review. 2022Age and Aging
Antithrombotic therapy with or without aspirin after percutaneous coronary intervention or acute coronary syndrome in patients taking oral anticoagulation: a meta-analysis and network analysis of randomized controlled trials. 2022Cardiovascular Revascularization Medicine
Comparative efficacy and safety of oral anticoagulants for the treatment of venous thromboembolism in the patients with different renal functions: A systematic review, pairwise and network meta-analysis. 2022BMJ Open
New oral anticoagulants for venous thromboembolism prophylaxis in total hip and knee arthroplasty: a systematic review and network meta-analysis. 2022Frontiers in Pharmacology
Direct oral anticoagulants for cancer-associated venous thromboembolisms: A systematic review and network meta-analysis. 2022Internal Medicine Journal
Antithrombotic therapy for secondary prevention of unprovoked venous thromboembolism: A systematic review and network meta-analysis of randomized controlled trials. 2022Annals of Medicine
Risk of intracranial hemorrhage with direct oral anticoagulants: A systematic review and meta‑analysis of randomized controlled trials. 2022Journal of Neurology
Comparative risks of fracture among direct oral anticoagulants and warfarin: A systematic review and network meta-analysis.2022Frontiers in Cardiovascular Medicine
Twice- or once-daily dosing of direct oral anticoagulants, a systematic review and meta-analysis. 2021Thrombosis Research
Safety and efficacy of apixaban, rivaroxaban, and warfarin in end-stage renal disease with atrial fibrillation: A systematic review and meta-analysis. 2021Cardiovascular Revascularization Medicine
Association of direct oral anticoagulants vs. vitamin K antagonists with fractures in atrial fibrillation patients: A systematic review and meta-analysis. 2021Frontiers in Cardiovascular Medicine
Comparison of non-vitamin K antagonist oral anticoagulants on bleeding and thrombosis. 2021Journal of Clinical Pharmacy and Therapeutics
Oral anticoagulant agents in patients with atrial fibrillation and CKD: A systematic review and pairwise network meta-analysis. 2021American Journal of Kidney Diseases
Severe bleeding risk of direct oral anticoagulants versus vitamin K antagonists for stroke prevention and treatment in patients with atrial fibrillation: A systematic review and network meta-analysis. 2021Cardiovascular Drugs and Therapy
Real-world persistence to direct oral anticoagulants in patients with atrial fibrillation: A systematic review and network meta-analysis. 2021Current Medical Research and Opinion
A network meta-analysis of non-vitamin K antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and diabetes mellitus. 2021Acta Cardiologica
Efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and liver disease: A meta-analysis and systematic review. 2021Cardiovascular Drugs and Therapy
Bleeding outcomes after dental Extraction in patients under direct-acting oral anticoagulants vs. vitamin K antagonists: A systematic review and meta-analysis. 2021Frontiers in Pharmacology
Reasons for discontinuing oral anticoagulation therapy for atrial fibrillation: A systematic review. 2021Age and Ageing
Effectiveness of direct oral anticoagulants in obese adults with atrial fibrillation: A systematic review of systematic reviews and meta-analysis.2021Frontiers in Cardiovascular Medicine
Efficacy and safety of non-vitamin K anticoagulants for atrial fibrillation in relation to different renal function levels: A network meta-analysis.2020Cardiovascular Therapeutics
Real-world adherence and persistence to direct oral anticoagulants in patients with atrial fibrillation: A systematic review and meta-analysis.2020Circulation: Cardiovascular Quality and Outcomes
Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation: A systematic review and meta-analysis.2020Frontiers in Pharmacology
Apixaban for stroke prevention in atrial fibrillation: why are event rates higher in clinical practice than in randomized trials?—A systematic review.2020Stroke, Systemic or Venous Thromboembolism
Efficacy and safety of direct oral anticoagulants in elderly patients with atrial fibrillation: a network meta-analysis.2020Frontiers in Medicine
The risk of gastrointestinal hemorrhage with non-vitamin K antagonist oral anticoagulants: a network meta-analysis.2020Medicine
Direct oral anticoagulant use in chronic kidney disease and dialysis patients with venous thromboembolism: a systematic review of thrombosis and bleeding outcomes. 2020Annals of Pharmacotherapy
A systematic review of direct oral anticoagulant use in chronic kidney disease and dialysis patients with atrial fibrillation.2019Nephrology Dialysis Transplantation
A systematic review of network meta-analyses and real-world evidence comparing apixaban and rivaroxaban in nonvalvular atrial fibrillation.2019Clinical and Applied Thrombosis/Hemostasis
Elderly bleeding risk of direct oral anticoagulants in nonvalvular atrial fibrillation: A systematic review and meta‑analysis of cohort studies.2019Drugs in R&D
Efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and high thromboembolic risk. a systematic review.2019Frontiers in Pharmacology
Non-vitamin K oral anticoagulants in nonvalvular atrial fibrillation: a network meta-analysis.2019Scandinavian Cardiovascular Journal
Comparison of transesophageal echocardiography findings after different anticoagulation strategies in patients with atrial fibrillation: a systematic review and meta-analysis.2019BMC Cardiovascular Disorders
Indirect comparison of novel oral anticoagulants among Asians with non-valvular atrial fibrillation in the real-world setting: A network meta-analysis.2019BMC Cardiovascular Disorders
Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis.2019Cochrane Database of Systematic Reviews

Clinical Practice Guidelines

Document TitleYearSource
Clinical Guides - Apixaban (Eliquis®)2024Thrombosis Canada
Recommendations for the safe use of direct oral anticoagulants in patients with cirrhosis based on a systematic review of pharmacokinetic, pharmacodynamic and safety data2024European Journal of Clinical Pharmacology
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines2024Journal Of The American College Of Cardiology
A review of latest clinical practice guidelines for the management of cancer-associated thrombosis.2022Best Practice & Research Clinical Haematology
2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19.2022The Lancet Oncology
2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).2020European Heart Journal
The 2020 Canadian cardiovascular society/Canadian heart rhythm society comprehensive guidelines for the management of atrial fibrillation.2020Canadian Journal of Cardiology
American Society of Hematology 2020 guidelines for management of venous thromboembolism: Treatment of deep vein thrombosis and pulmonary embolism.2020Blood Advances
Direct oral anticoagulant use: a practical guide to common clinical challenges.2020American Heart Association
2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.2019American Heart Association
Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update.2019Journal of Clinical Oncology