This promotional information is intended for healthcare professionals based
in the UK.
If you are not a healthcare professional in the UK, click here.
For Prescribing and Adverse Event reporting information, click here.

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.


ELIQUIS® in patients undergoing surgery and invasive procedures1

If surgery or invasive procedures cannot be delayed1

  • Appropriate caution should be exercised, taking into consideration an increased risk of bleeding
  • This risk of bleeding should be weighed against the urgency of intervention

ELIQUIS should be restarted after the invasive procedure or surgical intervention as soon as possible, provided the clinical situation allows and adequate haemostasis has been established1

Following surgery, other platelet aggregation inhibitors are not recommended concomitantly with ELIQUIS1

Catheter ablation (NVAF)1

ELIQUIS can be continued in patients undergoing catheter ablation (NVAF).

Spinal / epidural anaesthesia or puncture1

When neuraxial anaesthesia or spinal / epidural puncture is employed, patients treated with antithrombotic agents, such as ELIQUIS, are at risk of developing an epidural or spinal haematoma.1

Risk may be increased by:1

  • Post-operative indwelling epidural catheters; these must be removed at least 5 hours before the first dose of ELIQUIS is given
  • Concomitant use of medicinal products affecting haemostasis
  • Traumatic or repeated epidural or spinal puncture

Patients are to be frequently monitored for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent diagnosis and treatment is necessary.1

Prior to neuraxial intervention, the physician should consider the potential benefit vs. the risk in anticoagulated patients or in patients to be anticoagulated for thromboprophylaxis.1

Guidance for use prior to cardioversion1

ELIQUIS can be continued in patients with NVAF requiring cardioversion, who are already on long-term anticoagulation with ELIQUIS. ELIQUIS can also be initiated prior to cardioversion in patients previously untreated with anticoagulants by following the guidelines below.1,2

Decisions on the initiation and duration of treatment should take established guideline recommendations for anticoagulant treatment in patients undergoing cardioversion into account. For patients not previously treated with anticoagulants, exclusion of left atrial thrombus using an image guided approach (e.g., TOE or CT) prior to cardioversion should be considered, in accordance with established medical guidelines.1,2

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

For patients not previously treated with anticoagulants and eligible for early cardioversion:

  • TOE is recommended to exclude cardiac thrombus as an alternative to 3-week pre-procedural anticoagulation when early cardioversion is planned2

Confirmation should be sought prior to cardioversion that the patient has taken ELIQUIS as prescribed1

Patients already on ELIQUIS should continue taking ELIQUIS as prescribed1

  • For cardioversion of AF, effective anticoagulation is recommended for a minimum of 3 weeks before cardioversion2
  • In patients with AF duration of >24 h undergoing cardioversion, therapeutic anticoagulation should be continued for at least 4 weeks even after successful cardioversion to sinus rhythm (beyond 4 weeks, the decision about long-term OAC treatment is determined by the presence of stroke risk factors)2
  • In patients with a definite duration of AF ≤24 h and a very low stroke risk (CHA2DS2-VASc of 0 in men or 1 in women) post-cardioversion anticoagulation for 4 weeks may be omitted2

FOOTNOTES

AF = Atrial Fibrillation   BD = Twice Daily   CHA2DS2-VASc = Congestive heart failure, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65–74, Sex category (female)   CrCl = Creatinine Clearance   CT = Computed Tomography   
NVAF = Non-Valvular Atrial Fibrillation   TOE = Transoesophageal Echocardiography

REFERENCES

  1. ELIQUIS® (apixaban) Summary of Product Characteristics. Available at www.medicines.org.uk.
  2. Hindricks G et al. Eur Heart J 2020; 42: 373–498.