Eliquis

Common Uses

Eliquis is an anticoagulant, often called a blood thinner, that helps prevent blood from clotting too easily. It is approved for several specific conditions:

Atrial Fibrillation

It is used to lower the risk of stroke and dangerous blood clots in people with nonvalvular atrial fibrillation. This is a type of irregular heartbeat that is not caused by a heart valve problem.

Post-Surgery Prevention

Patients who have recently had hip or knee replacement surgery may be prescribed Eliquis. In these cases, it is used to prevent deep vein thrombosis (DVT), which are blood clots in the legs, and pulmonary embolism (PE), which are blood clots in the lungs.

Treatment of Blood Clots

Eliquis is used to treat patients who currently have DVT or PE. By thinning the blood, it helps prevent existing clots from getting larger and reduces the risk of new ones forming.

Prevention of Recurring Clots

After a patient has been treated for a blood clot in the legs or lungs, Eliquis may be used long-term to reduce the risk of those clots returning.

Mechanism of Action

Eliquis belongs to a class of medications known as Factor Xa inhibitors. It works by blocking the activity of Factor Xa, a natural substance in the blood that is necessary for blood to clot.

The clotting process involves a series of steps in the body:

• Factor Xa is an enzyme that helps the body produce thrombin.
• Thrombin is a protein that causes blood cells to stick together and form a solid clot.
• By blocking Factor Xa, Eliquis decreases the amount of thrombin available in the bloodstream.

By reducing the production of thrombin, the medication makes the blood less likely to form clots. This helps prevent dangerous blood clots from forming in the heart or blood vessels, which can lead to serious conditions such as a stroke or pulmonary embolism.

Common Side Effects

Some people may experience mild side effects while taking Eliquis. These often include:

• Easy bruising
• Minor nosebleeds
• Bleeding from the gums
• Nausea

Serious Side Effects

The most significant risk of Eliquis is serious bleeding. You should contact a doctor immediately or seek emergency care if you experience any of the following:

• Bleeding that will not stop
• Urine that appears red, pink, or brown
• Stools that are black, tarry, or contain bright red blood
• Coughing up blood or vomit that looks like coffee grounds
• Unexpected or heavy vaginal bleeding
• Severe headache, dizziness, or fainting
• Joint pain or swelling

Serious allergic reactions are rare but require immediate medical attention. Symptoms include a rash, hives, swelling of the face or throat, and difficulty breathing.

Boxed Warnings

Premature Discontinuation: Stopping Eliquis earlier than recommended increases the risk of blood clots or stroke. If the medication must be stopped for reasons other than major bleeding, another blood thinner may be required to prevent clotting events.

Spinal or Epidural Hematoma: There is a risk of blood clots forming in the spine (hematoma) for those taking Eliquis while undergoing spinal anesthesia or a spinal tap. These clots can lead to permanent paralysis. The risk is increased by the use of indwelling epidural catheters, a history of spinal surgery, or the concurrent use of other medications that interfere with blood clotting.

Bleeding Risk

Eliquis can cause serious and sometimes fatal bleeding because it lowers the body's ability to form clots. The risk of bleeding is increased when Eliquis is used with other drugs that affect blood clotting, including:

• Aspirin and other salicylates
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
• Warfarin or other anticoagulants
• Selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs)

Contraindications and Limitations

Active Bleeding: This medication should not be used by individuals with active major bleeding, such as a bleeding ulcer.

Prosthetic Heart Valves: Eliquis is not recommended for use in patients with prosthetic heart valves, as its safety and effectiveness have not been established in this population.

Antiphospholipid Syndrome: Use is not recommended for patients with triple-positive antiphospholipid syndrome (APS) due to a potential increase in the risk of recurrent blood clots.

Surgery and Procedures: Eliquis may need to be paused before surgical or dental procedures to reduce the risk of excessive bleeding. A healthcare provider will determine the appropriate timing for stopping and restarting the medication.

Pregnancy

The safety of Eliquis during pregnancy has not been established through clinical trials in humans. As a blood thinner, the medication carries a risk of causing bleeding in both the pregnant person and the fetus. Use during pregnancy is typically avoided unless a healthcare provider determines the potential benefit outweighs the risk. It is particularly important to discuss the use of this medication with a clinician if pregnancy is planned or occurs, especially regarding the risks of hemorrhage during labor and delivery.

Breastfeeding

It is currently unknown if Eliquis is excreted in human breast milk. Animal studies have indicated that the drug is present in the milk of lactating animals. Because of the risk of serious bleeding complications in a nursing infant, healthcare providers generally advise against breastfeeding while taking this medication. A decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the treatment to the parent.

Available Forms

Eliquis is supplied as a film-coated tablet intended for oral administration. These tablets are designed to be swallowed whole, though they may be crushed and mixed with water or other specific liquids for patients who have difficulty swallowing.

The tablets are typically available in different colors and shapes to help distinguish between them, though they are all taken by mouth.

FDA Approval and Indications

The U.S. Food and Drug Administration (FDA) first approved Eliquis (apixaban) in 2012. It is approved for the following indications:

• Reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
• Treating deep vein thrombosis (DVT) and pulmonary embolism (PE).
• Reducing the risk of DVT and PE recurring after initial treatment.
• Preventing DVT, which may lead to PE, in patients who have undergone hip or knee replacement surgery.

Boxed Warnings

The FDA requires a boxed warning for Eliquis due to serious safety risks:

• Risk of blood clots if discontinued early: Stopping Eliquis before a healthcare provider advises can increase the risk of having a stroke or developing blood clots. If the medication must be stopped for reasons other than serious bleeding or completion of a course of therapy, another anticoagulant may be necessary.
• Spinal or epidural hematoma: Patients taking Eliquis who undergo spinal anesthesia or a spinal puncture are at risk of developing a blood clot (hematoma) around the spine. This can result in long-term or permanent paralysis. The risk is higher for those using indwelling epidural catheters or other medications that affect blood clotting, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

Regulatory Status

Eliquis is a prescription-only medication. While it does not currently require a Risk Evaluation and Mitigation Strategy (REMS) program, it is subject to ongoing safety monitoring by the FDA. Patients are provided with a medication guide to explain the risks and proper use of the drug.

Factors Influencing Cost

The price you pay for Eliquis can vary significantly based on several variables:

• Insurance Coverage: Most private insurance plans and Medicare Part D cover Eliquis, but your specific copay or coinsurance will depend on your plan's formulary and your current coverage phase.
• Pharmacy Choice: Prices can differ between retail pharmacies, mail-order services, and local providers.
• Dosage and Quantity: The total cost may change depending on the strength prescribed and the number of tablets provided in each refill.

Generic Availability

While the FDA has approved generic versions of apixaban (the active ingredient in Eliquis), they may not be widely available at all pharmacies due to patent protections and legal agreements. Generic medications are typically less expensive than brand-name drugs once they enter the market.

Financial Assistance

The manufacturer of Eliquis may offer savings cards or patient assistance programs to help reduce out-of-pocket costs for eligible patients. Additionally, some non-profit organizations provide grants or resources to help cover the cost of anticoagulants for those who meet specific financial criteria.