Apixaban (Eliquis)
Apixaban (Eliquis) is a direct factor Xa inhibitor widely used for stroke prevention in nonvalvular atrial fibrillation, VTE treatment and secondary prevention, and post-surgical VTE prophylaxis. Its 2026 role is reinforced by large-scale real-world and trial data suggesting a favorable bleeding profile vs other DOACs.
- Mechanism of action
- Selective direct inhibitor of factor Xa, reducing thrombin generation and fibrin clot formation.
- Administration route
- Oral, twice daily
FDA-approved indications (2026)
Nonvalvular atrial fibrillation
Stroke and systemic embolism prevention (ARISTOTLE, AVERROES).
VTE treatment
DVT and PE treatment (AMPLIFY).
VTE secondary prevention
Extended prophylaxis after initial treatment (AMPLIFY-EXT).
VTE prophylaxis after hip/knee arthroplasty
Short-term post-surgical prophylaxis.
Dosing: adult, renal, and hepatic
| Population | Dose |
|---|---|
| AFib — standard | 5 mg PO BID. |
| AFib — reduced dose | 2.5 mg PO BID if ≥2 of: age ≥80, weight ≤60 kg, SCr ≥1.5 mg/dL. |
| VTE treatment | 10 mg PO BID × 7 days, then 5 mg BID × ≥6 months; 2.5 mg BID for extended prevention. |
| VTE prophylaxis (THA/TKA) | 2.5 mg PO BID × 12 days (knee) or 35 days (hip). |
| Renal impairment | ESKD / dialysis: 5 mg BID (2.5 mg BID if age ≥80 or weight ≤60 kg) — observational and PK-guided. |
| Hepatic impairment | Not recommended in severe (Child-Pugh C). Use cautiously in moderate (B). |
Contraindications and boxed warnings
Contraindications
- Active major bleeding.
- Serious hypersensitivity.
Boxed warnings
- Premature discontinuation increases thrombotic risk.
- Spinal/epidural hematoma risk with neuraxial anesthesia.
2026 guideline and pivotal trial position
ACC/AHA/ACCP/HRS 2023 AFib guideline recommends DOACs over warfarin for stroke prevention in nonvalvular AFib, with apixaban often preferred in patients at higher bleeding risk or CKD. CHEST 2024 and ACCP 2024 VTE guidance list apixaban as a preferred agent for acute VTE and extended prevention. 2026 practice reflects continued DOAC dominance.
ARISTOTLE
Superior to warfarin for stroke/SE prevention with lower major bleeding.
AVERROES
Superior to aspirin in AFib patients unsuitable for warfarin.
AMPLIFY / AMPLIFY-EXT
Noninferior to enoxaparin/warfarin for acute VTE with less bleeding; extended prevention data.
Cross-system reasoning
Apixaban anchors multispecialty coordination: cardiology (AFib stroke prevention), hematology (VTE), nephrology (dose adjustments), and gastroenterology/hepatology (bleeding risk and cirrhosis contraindication). In patients considered for anti-amyloid mAb therapy (lecanemab, donanemab), anticoagulation status materially affects ARIA-H risk, creating a neurology-cardiology-hematology decision node that did not exist a decade ago.
Key references
- FDA Label — Eliquis
- Granger CB, et al. ARISTOTLE (NEJM 2011)PMID: 21870978
- Agnelli G, et al. AMPLIFY (NEJM 2013)PMID: 23808982
Related clinical reading
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This reference is for US-licensed physicians and is not a substitute for the full FDA prescribing information. Dosing in special populations, drug interactions, and emerging safety information should be verified against the current manufacturer label and society guidelines before prescribing.