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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.
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
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