Dr. Richard Hoffmann, Ask the Pharmacist, 02/05/13

Q: I heard about a new drug to reduce strokes and blood clots in people with atrial fibrillation. What can you tell me about it?

A: In late December 2012, the FDA approved the anti- clotting drug Eliquis (apixaban), an oral tablet used to reduce the risk of stroke and dangerous blood clots (systemic embolism) in patients with atrial fibrillation (A-Fib or AF) not caused by a heart valve problem.

Atrial fibrillation, one of the most common types of abnormal heart rhythm, is an abnormal, irregular and rapid beating of the heart in which the heart’s two upper chambers (atria) do not contract properly, allowing blood clots to form in them. These clots can break off and travel to the brain or other parts of the body.

The safety and efficacy of Eliquis in treating patients with atrial fibrillation not caused by cardiac valve disease were studied in a clinical trial of more than 18,000 patients that compared Eliquis with the anti-clotting drug Coumadin (warfarin).

In the trial, patients taking Eliquis had fewer strokes than those who took Coumadin (warfarin). Patients with prosthetic heart valves should not take Eliquis nor should patients with atrial fibrillation that is caused by a heart valve problem. These patients were not studied in clinical trials.

As with other FDA-approved anti-clotting drugs, bleeding, including life-threatening and fatal bleeding, is the most serious risk with Eliquis. Eliquis is the third oral anticoagulant to be approved in the United States for this use, with the other two being Pradaxa (dabigatran) and Xarelto (rivaroxaban).

Unlike Coumadin (warfarin), all three of these new drugs do not require regular coagulation laboratory monitoring and they also have a less likelihood of drug interactions. However, there is no agent that can reverse the anticoagulant effect of these three new drugs if bleeding should occur.

Eliquis is dosed orally twice daily and will be dispensed with a patient Medication Guide that provides instructions on its use and drug safety information.

Richard P. Hoffmann, Pharm.D., has been a pharmacist for more than 40 years. Send questions to him at 2960 E. Coventry Court, Hernando, FL 34442.