Apixaban Pharmacotherapy Management: A Current and Updated Review

Introduction: To prevent strokes or blood clots in patients with atrial fibrillation, apixaban has been preferred for prescription compared with vitamin K antagonists. This review summarizes the findings of previous studies related to apixaban pharmacotherapy. Methods: For potential relevance, the titles and abstracts of all records obtained from databases were screened, and 120 articles were included in this study. Results: In individuals with nonvalvular atrial fibrillation and venous thromboembolism, apixaban demonstrated efficacy in preventing atrial thromboembolic events. In elderly patients aged >80 years, those with a body weight <60 kg, and individuals with serum creatinine >1.5 mg/dl, a dose reduction is suggested. Simultaneous intake of grapefruit, pomelos, limes, marmalades, garlic, ginger, chamomile tea, green tea, turmeric, ginkgo biloba, vitamin E, fish oil, and St. John’s wort necessitates vigilance. Anaemia, gastrointestinal disorders, melena, haemorrhagic anaemia, gastrointestinal haemorrhage, haematuria, decreased haemoglobin, and intracranial haemorrhage were reported when apixaban was taken with drugs such as acenocoumarol, acetylsalicylic acid, allopurinol, amiodarone, celecoxib, citalopram, clopidogrel, and dabigatran. Discussion: Apixaban, or Eliquis, acts by direct inhibition of coagulation factor Xa (thrombokinase), which is synthesised in the liver. For reducing thromboembolic events and stroke, apixaban is recommended to be more effective than rivaroxaban, warfarin, and dabigatran, with a lower risk of bleeding and intracranial haemorrhage. Conclusion: Determining the vitamin E/cholesterol ratio in patients with nonvalvular atrial fibrillation is important. Polypharmacy with ketoconazole, diltiazem, sildenafil, tadalafil, vardenafil, cyclosporine, clarithromycin, enoxaparin, amiodarone, and naproxen requires further attention.