Apixaban (Eliquis®): Uses, uses and side effects to note

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Article by Pharmacist, Master Nguyen Hoang Phuong Khanh - Clinical Pharmacist - Faculty of Pharmacy - Vinmec Central Park International General Hospital
Apixaban is indicated for the prevention of stroke and embolism in patients with nonvalvular atrial fibrillation, treatment of deep vein thrombosis and pulmonary embolism, and prophylaxis of venous thromboembolism in patients undergoing knee replacement or hip replacement. To use the drug effectively and safely, the patient needs to follow the instructions of the doctor, the pharmacist who prescribes it.

1. What does Apixaban do?

Apixaban (brand name Eliquis®) is one of the new generation oral anticoagulants. Compared with warfarin, the drug is equally effective and has a lower bleeding rate, especially in the brain. New generation oral anticoagulants have a relatively wide therapeutic range, do not need frequent monitoring and testing to adjust the dose to ensure effects and limit side effects. In addition, the drug rarely interacts with other drugs and almost does not require attention on the diet like vitamin K antagonists.
Apixaban is indicated:
Prevention of stroke and embolism in patients with atrial fibrillation nonvalvular (atrial fibrillation is a common arrhythmia). Treatment of deep vein thrombosis and pulmonary embolism. In addition, the drug is also used to prevent venous thrombosis in patients undergoing knee or hip replacement. However, it is worth noting that the drug should not be used to prevent thrombosis after the patient has undergone prosthetic valve replacement (mechanical or biological), LVAD, TAVR, because some may cause some unwanted side effects. Therefore, if the patient has a history of previous prosthetic heart valve replacement, it is necessary to inform the treating doctor so that the drug can be selected safely and best for the patient.
2. How to take Apixaban Take Apixaban exactly as prescribed by your doctor, do not increase or decrease the dose or stop taking it without consulting your doctor.
In case the patient cannot swallow the whole tablet, the drug can be crushed and dissolved with 60ml of water (sugar juice or apple juice). The drug should be used immediately after reconstitution.
In case the patient wants to change to another oral anticoagulant, contact the doctor.
Medicines should be taken at fixed times of the day. If you forget to take your medicine within 6 hours, you can take 1 tablet and continue with the next dose. If it's been more than 6 hours, stop taking the missed dose, wait until your next dose, and take only 1 pill. Do not take a double dose.
Forgetting to take your medicine increases the risk of blood clots, so make sure you always have a spare at home.

3. What are the side effects of the drug to watch out for?

All anticoagulants increase the risk of bleeding. Bleeding symptoms can be mild or severe, for example:
Mild symptoms include signs of light bleeding and rapid stopping of bleeding, such as nosebleeds, bleeding gums (you should choose the type of brush you should choose). soft bristles for brushing), minor bruising under the skin. More severe symptoms that require you to contact your doctor: Pale skin, feeling very weak, fatigue, shortness of breath, chest pain ; vomiting blood or passing black, red stools with a fishy smell; prolonged bleeding during the menstrual cycle; all other bleedings that take a long time to stop;... To reduce the risk of bleeding, you need to limit contact with sharp tools such as sharp knives, razors. Limit activities that cause bleeding injuries such as climbing, running, jumping...
In case you forget to take your medicine for a long time, you are likely to have a blood clot or a stroke. Inform your doctor if you experience the following symptoms:
Lung signs: Chest pain, fast heartbeat, shortness of breath, fever. Signs in hands or feet: Sudden pain, swelling, heat, tightness. Signs of a stroke: Slurred speech, unable to speak, facial weakness, hemiplegia. In case you want to have surgery or have procedures related to bleeding such as tooth extraction, spinal intervention, it is necessary to inform the medical staff that you are taking anticoagulants so that the doctor can consider the treatment. Discontinue medication if necessary. Inform your doctor if you intend to become pregnant while taking this medication or are breast-feeding. 4. Food, drugs to avoid when using Apixaban Some drugs can affect the concentration of Apixaban, for example Carbamazepine, Itraconazole, Ketoconazole, Phenytoin, Rifampin, Ritonavir or supplements containing St. John's wort. Inform your doctor if you are taking these medications. Antiplatelet drugs (Aspirine, Clopidogrel, Ticagrelor...); non-steroid anti-inflammatory drugs (Ibuprofen, Diclofenac...); Antidepressants of the SSRI class have the potential to increase the risk of bleeding when patients take them. Therefore, you should consult your doctor before you want to take any other medicine, including supplements and herbal medicines. Limit the use of alcoholic beverages. You do not need regular follow-up tests to check your Apixaban levels. Apixaban is poorly eliminated by the kidneys, so you need to monitor your kidney function at least once a year. For patients with impaired renal function, more frequent monitoring is indicated to adjust the dose. Talk to your doctor if you have impaired liver function. In summary, Apixaban is indicated for the prevention of stroke and embolism in patients with non-valvular atrial fibrillation, the treatment of deep vein thrombosis and pulmonary embolism, and the prevention of venous thromboembolism in patients undergoing joint replacement. knee or hip replacement.

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References:
Apixaban package insert Uptodate 2021 Apixaban/Patient and family information/Thrombosis Canada Apixaban/Mayo Clinic Apixaban/Patient and family instructions/Massachusetts general hospital