Eliquis Uses: How Apixaban is Used (Guide)

Eliquis: Reducing the Risk of Cardiovascular Accidents

Eliquis (apixaban) is an anticoagulant (blood thinner) that helps to reduce blood clotting and reduces risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Apixaban (or Eliquis) is also used to treat or prevent deep venous thrombosis, a condition in which harmful blood clots form in the blood vessels of the legs.

Key Takeaways

Eliquis (apixaban) is an anticoagulant (blood thinner) that helps to reduce blood clotting and reduces risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
In addition, Eliquis (apixaban) can be used for deep vein thrombosis (DVT), pulmonary embolism (PE), post-surgical DVT/PE prevention, and DVT/PE recurrence prevention. In many cases, it will be prescribed in post-surgical scenarios as a blood-thinner to prevent blood clotting.

Eliquis Uses: Apixaban

Eliquis (apixaban) is prescribed to reduce the risk of stroke and blood clots in patients with atrial fibrillation, an irregular heartbeat that increases stroke risk. Additionally, Eliquis (apixaban) helps to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) following more common hip or knee replacement surgeries. As a result, Eliquis (apixaban) is more commonly prescribed to elderly patients. Apixaban (or Eliquis) is also used to treat or prevent deep venous thrombosis, a condition in which harmful blood clots form in the blood vessels of the legs.

Eliquis (apixaban) may also be prescribed to patients who are unsuitable for warfarin therapy. In a study cited by Dr. Despina Menual Toader, “In the trial, the rate of stroke/SE was significantly reduced with apixaban, compared to aspirin, with similar effects on major bleedings or ICH, irrespective of age. This suggests that apixaban should be considered a viable alternative, especially for elderly patients ≥80 years unsuitable for warfarin therapy.”

Condition	Use	Details
Atrial Fibrillation (AFib)	Stroke and blood clot prevention	Used in patients with nonvalvular AFib to reduce the risk of stroke and systemic embolism.
Deep Vein Thrombosis (DVT)	Treatment and prevention	Treats DVT and reduces the risk of recurrence of DVT after initial therapy.
Pulmonary Embolism (PE)	Treatment and prevention	Treats PE and reduces the risk of recurrent PE after initial treatment.
Post-Surgical DVT/PE Prevention	Blood clot prevention after surgery	Prevents DVT, which could lead to PE, in patients who have undergone hip or knee replacement surgery.
DVT/PE Recurrence Prevention	Long-term blood clot prevention	Reduces the risk of DVT and PE recurrence in patients who have completed at least 6 months of treatment.

How Eliquis (Apixaban) Works

Eliquis (apixaban) is considered a blood thinner or anticoagulant. In the clotting process, there are several specific proteins and enzymes—often referred to as clotting factors—that work together in a series of steps known as the coagulation cascade.

Blood thinners interfere with certain steps in this cascade:

Warfarin: This anticoagulant blocks the enzyme vitamin K epoxide reductase, which is essential for recycling vitamin K in the body. Vitamin K is needed to activate several clotting factors, particularly Factors II (prothrombin), VII, IX, and X. By blocking vitamin K's recycling, warfarin indirectly reduces the production of these clotting factors, which slows down the blood's ability to clot.
Heparin and Low Molecular Weight Heparins (Enoxaparin): Heparin works by enhancing the activity of antithrombin, a natural anticoagulant in the body that inactivates clotting factors like thrombin (Factor IIa) and Factor Xa. This inactivation slows down the formation of fibrin, the protein that forms the structural "mesh" of a blood clot.
Direct Factor Xa Inhibitors (Apixaban, Rivaroxaban): These drugs specifically inhibit Factor Xa, a key enzyme that converts prothrombin (Factor II) into thrombin (Factor IIa). By blocking Factor Xa, these drugs prevent the generation of thrombin, thus reducing fibrin formation.
Direct Thrombin Inhibitors (Dabigatran): These anticoagulants target thrombin (Factor IIa) directly. Thrombin is responsible for converting fibrinogen to fibrin, which is essential for clot formation. By inhibiting thrombin, these drugs prevent the formation of fibrin and, thus, the development of a clot.

Each class of blood thinner disrupts a different point in the coagulation cascade, which allows healthcare providers to choose the most appropriate option depending on a patient's specific condition and clotting risk factors.

How Eliquis (Apixaban) is Administered

The usual dose in adults with a heart condition called atrial fibrillation is one 5mg tablet, usually taken twice per day. Your primary care provider may prescribe a lower dose of one 2.5mg tablet twice a day if you're over 80 years old, weigh less than 60kg (9st 6lb), or have existing or near conditions of kidney disease and are generally at higher risk of bleeding.

Eliquis (Apixaban) General Dosage Chart:

Condition	Standard Dosage	Duration/Frequency
Atrial Fibrillation (AFib)	5 mg orally, twice daily	Ongoing (long-term)
Dose adjustment for AFib patients:	2.5 mg twice daily if the patient meets two of the following criteria: Age ≥ 80 years Body weight ≤ 60 kg (132 lbs) Serum creatinine ≥ 1.5 mg/dL	Ongoing (long-term)
Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Initial treatment	10 mg orally, twice daily	For the first 7 days
DVT/PE treatment: Continued therapy	5 mg orally, twice daily	After 7 days
DVT/PE Prevention (after initial treatment)	2.5 mg orally, twice daily	After at least 6 months of treatment
Post-Op DVT/PE Prevention (hip replacement)	2.5 mg orally, twice daily	For 35 days after surgery
Post-Op DVT/PE Prevention (knee replacement)	2.5 mg orally, twice daily	For 12 days after surgery

Common Eliquis (Apixaban) Questions

Below are common questions about Eliquis (apixaban):

Is Eliquis hard on your kidneys?

There haven’t been any direct studies related to issues that Eliquis (apixaban) causes on the kidneys. In addition, there aren’t any kidney-related side effects, such as kidney damage or reduced kidney function. However, Eliquis (apixaban) can sometimes cause serious bleeding. This may include bleeding in organs such as the kidneys.

What vitamins should I stop taking if I’m on Eliquis?

If a patient is taking blood thinning medications, they should stop taking supplements like fish oil, krill oil, vitamin E, garlic, and bromelain, as these can potentially increase the risk of bleeding due to their blood-thinning properties.

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Sources

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Cleveland Clinic. (2023). Prothrombin Gene Mutation. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21810-prothrombin-gene-mutation
Sigma-Aldrich. (n.d.). Thrombins. Sigma-Aldrich Technical Documents. Retrieved November 4, 2024, from https://www.sigmaaldrich.com/US/en/technical-documents/technical-article/research-and-disease-areas/metabolism-research/thrombins
National Library of Medicine. (2023). Effects of Apixaban in Older Adults: A Systematic Review and Meta-analysis. National Center for Biotechnology Information. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10643025/
U.S. Food and Drug Administration. (2012). Eliquis (Apixaban) Label. FDA Drug Label Database. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/202155s000lbl.pdf