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ELIQUIS® (apixaban) is indicated for prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF), with one or more risk factors, such as prior stroke or transient ischaemic attack (TIA), age ≥75 years, hypertension, diabetes mellitus, symptomatic heart failure (NYHA Class ≥II); treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults; and, prevention of venous thromboembolic events (VTE) in patients who have undergone elective hip or knee replacement surgery.


Dosing considerations in patients with renal or hepatic impairment

Dosing considerations in patients with impaired renal function1

Dosing considerations in patients with hepatic impairment across all indications1

Prior to initiating ELIQUIS, liver function testing should be performed.1

The EHRA recommends that patients with NVAF undergoing treatment with DOACs have blood samples taken yearly to assess haemoglobin, renal function and liver function.2

If patients are ≥75 years old or frail,* samples should be taken every 4 months.2 For patients with impaired renal function (CrCl ≤60 ml/min), samples should be taken x-monthly, where x = CrCl/10. Renal function should be checked when necessary. Renal function should be checked immediately in patients with intercurrent conditions.2

ELIQUIS is not recommended in patients with CrCl <15 ml/min, or in patients undergoing dialysis.1

FOOTNOTES

ELIQUIS, dabigatran, rivaroxaban and edoxaban are all recommended by NICE Guideline 196 (NICE NG196, 2021) as anticoagulation therapy options for the prevention of stroke in patients with NVAF in line with their respective marketing authorisations.3 These DOACs have received NICE Technology Appraisal guidance (NICE TA249 [dabigatran],5 NICE TA256 [rivaroxaban],6 NICE TA275 [apixaban]7 and NICE TA355 edoxaban]),8 and all DOACs are recommended as an option for preventing stroke and systemic embolism in patients with NVAF and one or more risk factors, in line with their respective marketing authorisations.3

* Frailty is defined as three or more criteria of unintentional weight loss, self-reported exhaustion, weakness assessed by handgrip test, slow walking speed or low physical activity.4

ALT = Alanine Aminotransferase   AST = Aspartate Aminotransferase   BD = Twice Daily   CrCl = Creatinine Clearance   DOAC = Direct-acting Oral Anticoagulant   
DVT = Deep Vein Thrombosis   eGFR = Estimated Glomerular Filtration Rate   
EHRA = European Heart Rhythm Association   NICE = National Institute for Health and Care Excellence   NVAF = Non-Valvular Atrial Fibrillation   PE = Pulmonary Embolism   ULN = Upper Limit of Normal

REFERENCES

  1. ELIQUIS® (apixaban) Summary of Product Characteristics. Available at www.medicines.org.uk.
  2. Steffel J et al. Europace 2021; doi:10.1093/europace/euab065.
  3. NICE NG196. Atrial fibrillation: management. April 2021.
  4. Xue QL et al. Clin Geriatr Med 2011; 27: 1–15.
  5. NICE technology appraisal guidance TA249. Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation. March 2012.
  6. NICE technology appraisal guidance TA256. Rivaroxaban for the prevention of stroke and systemic embolism in atrial fibrillation. May 2012.
  7. NICE technology appraisal guidance TA275. Apixaban for preventing stroke and systemic embolism in people with NVAF. February 2013.
  8. NICE technology appraisal guidance TA355. Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation. September 2015.