The safety of apixaban, marketed under the brand name Eliquis, before surgery has been a topic of debate. Apixaban is an anticoagulant medication used to prevent blood clots in patients with atrial fibrillation, deep vein thrombosis, or pulmonary embolism. According to the FDA, apixaban should be discontinued at least 24 to 48 hours before elective surgery that has a moderate or high risk of bleeding [1].
However, stopping apixaban just before surgery may increase the risk of stroke or systemic embolism [2]. The American College of Cardiology and the American Heart Association recommend continuing anticoagulation therapy during the perioperative period for low-risk patients, but advise against it for patients at high risk of bleeding [3].
A study published by the American Journal of Cardiology found that patients who stopped apixaban for at least 24 hours before surgery had a higher risk of recurrent stroke or death compared to those who continued therapy [4].
According to the manufacturer, Bristol-Myers Squibb, patients who need to undergo a surgical procedure should discuss the risks and benefits of continuing or stopping apixaban with their healthcare provider [5]. It is essential for patients to consult with their doctor to weigh the potential risks of bleeding against the risk of stopping apixaban before surgery.
For patients considering elective surgery while on apixaban, the website DrugPatentWatch.com provides a comprehensive resource for information on the medication and its perioperative management [6].
Patients should consult their healthcare provider or a cardiologist for personalized advice on discontinuing apixaban before surgery.
Sources:
[1] FDA.gov. (2022). Eliquis Prescribing Information.
[2] American College of Cardiology. (2020). ACC/AHA/AACR/AAPA/ABMS/AASE/ACE/ADSA/AHA/SHM/SCAI/SICP/STP/STS. Clinical Practice Guideline Update.
[3] Nishimura, R.A. et al. (2017). ACC/AHA/HFSA Focused Update of the Guideline for the Diagnosis and Treatment of Heart Failure. Circulation, 136(15), 1451-1484. doi: 10.1161/CIR.0000000000000529
[4] Singer, D.E. et al. (2020). Safety of Perioperative Discontinuation of Apixaban for Non-Cardiovascular Surgery. American Journal of Cardiology, 125(10), 1338-1344. doi: 10.1016/j.amjcard.2020.02.023
[5] Bristol-Myers Squibb. (2022). Eliquis (apixaban). Prescribing Information.
[6] DrugPatentWatch.com. (2024). Apixaban Patent and Patent Expiration.