Eliquis: Advanced Stroke and Blood Clot Prevention
| Product dosage: 2.5mg | |||
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| Product dosage: 5mg | |||
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Synonyms | |||
Eliquis (apixaban) is a next-generation oral anticoagulant designed to significantly reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. It is also indicated for the prophylaxis of deep vein thrombosis (DVT) following hip or knee replacement surgery, and for the treatment and secondary prevention of DVT and pulmonary embolism (PE). As a direct Factor Xa inhibitor, Eliquis offers a targeted mechanism of action with predictable pharmacokinetics, reducing reliance on routine coagulation monitoring and providing a favorable benefit-risk profile in appropriate patient populations. Its clinical efficacy is supported by robust trial data demonstrating superiority or non-inferiority to warfarin in key outcomes.
Features
- Contains apixaban as the active pharmaceutical ingredient
- Available in 2.5 mg and 5 mg film-coated tablets
- Direct, selective, and reversible Factor Xa inhibition
- Predictable anticoagulant effect with no requirement for routine INR monitoring
- Dual elimination pathway: approximately 25% renal excretion and 75% non-renal (primarily hepatic and intestinal)
- Rapid onset of action with peak plasma concentrations within 3–4 hours post-administration
- Fixed dosing regimen without need for titration in most cases
Benefits
- Superior reduction in the risk of stroke or systemic embolism compared to warfarin in patients with non-valvular atrial fibrillation
- Significantly lower rates of major bleeding and intracranial hemorrhage relative to warfarin
- Consistent anticoagulant effect without dietary restrictions related to vitamin K intake
- Convenient twice-daily dosing without routine blood test monitoring
- Reduced risk of all-cause mortality in long-term anticoagulation management
- Effective prevention of venous thromboembolism following major orthopedic surgery
Common use
Eliquis is commonly prescribed for stroke prevention in adult patients with non-valvular atrial fibrillation who have one or more risk factors for stroke, such as prior stroke or transient ischemic attack, age ≥75 years, hypertension, diabetes mellitus, congestive heart failure, or vascular disease. It is also widely used for prophylaxis of DVT in patients undergoing elective hip or knee replacement surgery, and for the treatment of acute DVT and PE, as well as reduction in the risk of recurrent DVT and PE following initial therapy.
Dosage and direction
For stroke prevention in non-valvular atrial fibrillation: The recommended dose is 5 mg taken orally twice daily. For patients with at least two of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, the recommended dose is 2.5 mg twice daily.
For DVT prophylaxis following hip or knee replacement surgery: 2.5 mg twice daily, initiated 12–24 hours post-surgery. Treatment duration is 35 days for hip replacement and 12 days for knee replacement surgery.
For treatment of DVT/PE and reduction in recurrence risk: 10 mg twice daily for 7 days, followed by 5 mg twice daily. For continued risk reduction, maintenance dose is 2.5 mg twice daily after at least 6 months of standard therapy.
Tablets should be swallowed whole with water, with or without food. Do not break, crush, or chew tablets.
Precautions
Regular assessment of renal function is recommended, particularly in elderly patients or those with comorbid conditions. Use with caution in patients with moderate hepatic impairment (Child-Pugh B); not recommended in severe hepatic impairment. Monitor for signs of bleeding or anemia. Consider discontinuation至少 48 hours before elective surgery or invasive procedures with moderate or high risk of bleeding. Spinal or epidural hematomas may occur in patients receiving neuraxial anesthesia or undergoing spinal puncture; monitor frequently for neurologic impairment. Not recommended in patients with prosthetic heart valves or significant valvular heart disease.
Contraindications
Active pathological bleeding. Severe hypersensitivity reaction to apixaban or any component of the formulation. Concomitant use with strong dual inhibitors of both CYP3A4 and P-glycoprotein, such as itraconazole, ketoconazole, ritonavir, or clarithromycin.
Possible side effects
Most common adverse reactions (>1%) include:
- Bleeding events (may range from minor epistaxis to major hemorrhage)
- Nausea
- Anemia
- Bruising
- Elevated liver enzymes
Serious but less common side effects may include:
- Spinal or epidural hematoma
- Severe allergic reactions
- Hepatotoxicity
- Thrombocytopenia (rare)
Drug interaction
Strong dual inducers of CYP3A4 and P-glycoprotein (e.g., rifampin, carbamazepine, St. John’s wort) may decrease apixaban concentrations. Anticoagulants, antiplatelet agents, NSAIDs, and SSRIs may increase bleeding risk. Use with caution with strong dual inhibitors of CYP3A4 and P-glycoprotein in patients with renal impairment. Monitor patients closely when used with other drugs affecting hemostasis.
Missed dose
If a dose is missed, the patient should take it as soon as possible on the same day and then resume the twice-daily regimen. Do not double the dose to make up for a missed dose.
Overdose
Overdose may lead to hemorrhagic complications. No specific antidote exists; management should focus on symptomatic treatment and supportive care. Activated charcoal may be considered if administered shortly after ingestion. In cases of life-threatening bleeding, consider procoagulant agents such as prothrombin complex concentrate, activated prothrombin complex concentrate, or recombinant Factor VIIa, though their utility has not been evaluated in clinical trials. Dialysis is not expected to enhance elimination.
Storage
Store at room temperature (20–25°C/68–77°F); excursions permitted to 15–30°C (59–86°F). Keep in original container with tight closure. Protect from moisture and light. Keep out of reach of children and pets.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by a qualified healthcare professional based on individual patient characteristics. Always follow the prescribing information provided with the medication and consult with a healthcare provider regarding any questions or concerns about therapy.
Reviews
Clinical trials and real-world evidence consistently demonstrate Eliquis’ efficacy in stroke prevention and venous thromboembolism management. The ARISTOTLE trial showed a 21% reduction in stroke/systemic embolism, 31% reduction in major bleeding, and 11% reduction in all-cause mortality compared to warfarin. Real-world studies have confirmed these benefits in diverse patient populations, with particular note of its favorable safety profile in elderly patients and those with renal impairment. Patient satisfaction surveys indicate high adherence rates due to the convenient dosing schedule and absence of dietary restrictions.