Eliquis

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What Is Eliquis?

Eliquis is 2.5 / 5 mg apixaban tablets from Bristol-Myers Squibb / Pfizer, supplied in 10-180 tablets. Apixaban was approved by the FDA in 2012 and is the most widely prescribed DOAC in many markets. ARISTOTLE (2011) showed superiority over warfarin for stroke prevention in AF with less major and intracranial bleeding; AMPLIFY (2013) showed non-inferiority to enoxaparin/warfarin for VTE treatment with less major bleeding.

How Apixaban Works

Apixaban directly and reversibly inhibits factor Xa, the central convergence point of the intrinsic and extrinsic coagulation cascades, reducing thrombin generation and clot formation. Half-life is approximately 12 hours; about 27% renally cleared, the rest hepatic and biliary. Twice-daily dosing maintains stable anticoagulation.

Approved Uses

• Non-valvular atrial fibrillation — stroke and systemic embolism prevention (ARISTOTLE)
• Acute venous thromboembolism (DVT and PE) — treatment (AMPLIFY)
• Extended VTE secondary prevention — after 6+ months of treatment (AMPLIFY-EXT)
• VTE prophylaxis after major orthopaedic surgery — total hip / knee replacement (ADVANCE)
• Aspirin-intolerant AF stroke prevention (AVERROES) — superior to aspirin without increased major bleeding

Dosage

Take with or without food. If a dose is missed, take it as soon as possible the same day, then resume the normal twice-daily schedule — do not double up.

Bleeding Risk and Monitoring

No routine blood monitoring required — a major practical advantage over warfarin. Check baseline FBC, renal and hepatic function. Recheck renal function at 3-12 month intervals depending on baseline CrCl, age, and acute illness. Apixaban has the lowest GI bleeding rate of the available DOACs. Major bleeding ~2-3%/year in AF. Watch for melaena, haematemesis, fresh rectal bleeding, haematuria, intracranial bleed symptoms, unexplained anaemia, or unusually heavy menstrual loss.

Side Effects

• Major bleeding (~2-3%/year in AF, lower than warfarin)
• Minor bleeding: epistaxis, gum bleeding, bruising, menorrhagia
• Anaemia
• Nausea
• Hypersensitivity reactions, rare
• Hepatotoxicity, rare

Contraindications

• Active pathological bleeding
• Mechanical heart valve (use warfarin — RE-ALIGN)
• Moderate-to-severe (rheumatic) mitral stenosis (use warfarin)
• Antiphospholipid syndrome, especially triple-positive (use warfarin — TRAPS)
• Severe hepatic impairment (Child-Pugh B or C)
• End-stage renal failure (CrCl <15 mL/min) or dialysis — limited evidence
• Concurrent strong dual CYP3A4 + P-gp inhibitors (azole antifungals, HIV protease inhibitors)
• Pregnancy and breastfeeding

Drug Interactions

• Strong CYP3A4 + P-gp dual inhibitors (ketoconazole, itraconazole, ritonavir, clarithromycin) — substantially raise apixaban levels; contraindicated.
• Strong CYP3A4 + P-gp inducers (rifampicin, phenytoin, carbamazepine, St John’s wort) — lower levels; avoid or use alternative.
• Other anticoagulants and antiplatelets (warfarin, DOACs, heparins, aspirin, clopidogrel, NSAIDs) — additive bleeding risk; combine only when clinically indicated.
• SSRIs/SNRIs — modest additive bleeding risk via platelet serotonin depletion.

Reversal of Anticoagulation

For major bleeding or urgent surgery, andexanet alfa is the specific reversal agent. Where unavailable, 4-factor prothrombin complex concentrate (4F-PCC, 50 IU/kg) is used. Activated charcoal within 2 hours of ingestion may be considered. Apixaban has high protein binding so dialysis is not effective.

Surgery and Dental Procedures

For most surgery, stop apixaban 24-48 hours before depending on bleeding risk and renal function (longer for major surgery or impaired renal function). Most simple dental procedures can be done without stopping. Resume 24 hours after low-risk surgery and 48-72 hours after high-risk surgery once haemostasis is secured. Bridging is generally not required.

Pregnancy and Breastfeeding

Pregnancy: contraindicated — crosses placenta; use LMWH. Breastfeeding: avoid — transfer to milk likely.

Storage

Store Eliquis below 25°C in the original blister pack. Keep out of reach of children.

Frequently Asked Questions

Do I need blood tests on Eliquis?

No routine test for efficacy. Check renal and hepatic function at baseline and at 3-12 month intervals depending on age, baseline CrCl, and acute illness.

Why is apixaban dosed twice daily?

Apixaban has a 12-hour half-life; twice-daily dosing maintains more stable anticoagulation than once-daily alternatives. The trade-off is one extra daily dose for arguably the cleanest bleeding profile of the DOACs.

Why does the dose drop to 2.5 mg twice daily for some patients?

In non-valvular AF, dose-reduce to 2.5 mg BID if any two of: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL (133 micromol/L). This avoids excessive drug accumulation and bleeding risk in the most vulnerable patients.

What if I miss a dose?

Take it as soon as possible the same day, then resume the normal twice-daily schedule. If you miss two consecutive doses or skip a whole day, do not double up — resume the normal schedule and contact your prescriber for advice.

Can I take Eliquis for a mechanical heart valve?

No. The RE-ALIGN trial showed DOACs (dabigatran) caused more thromboembolic and bleeding events than warfarin in mechanical valve patients. Warfarin is the only acceptable oral anticoagulant for mechanical valves and rheumatic mitral stenosis.

Can I switch from warfarin to Eliquis?

Yes — in non-valvular AF and most VTE indications. Stop warfarin, check the INR, and start apixaban once the INR is <2.0. Speak with your anticoagulation clinic before switching.

What if I cut myself while on Eliquis?

Apply firm direct pressure for 15-20 minutes. Most minor cuts stop normally. Bleeding that continues >20 minutes, black or bloody stools, blood in urine, unusual bruising, severe headache, or unexplained heavy menstrual bleeding warrant urgent medical review.

Can I take Eliquis in pregnancy?

No — DOACs are contraindicated in pregnancy and breastfeeding. LMWH is the anticoagulant of choice in pregnancy.

What if I need surgery?

Inform your surgeon and anticoagulation clinic well in advance. Apixaban is typically stopped 24-48 hours before surgery depending on bleeding risk and renal function. Bridging with heparin is usually not required.

Where can I buy Eliquis online?

You can buy Eliquis (2.5 / 5 mg apixaban, 10-180 tablets) from MedsBase with discreet packaging and worldwide shipping.

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