Apixaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation

Apixaban (Eliquis, Bristol–Myers Squibb and Pfizer) is a potent, oral, direct and highly selective active site inhibitor of factor Xa. By inhibiting factor Xa, apixaban prevents thrombin generation and thrombus development. Apixaban 5 mg twice daily and 2.5 mg twice daily has a European marketing authorisation for the 'prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation, with 1 or more risk factors, such as prior stroke or transient ischaemic attack, age 75 years or older, hypertension, diabetes mellitus, or symptomatic heart failure (New York Heart Association [NYHA] class 2 or higher)'.

The summary of product characteristics lists the following adverse reactions for apixaban: epistaxis (nosebleed), contusion (bruising), haematuria (blood in urine), haematoma, eye haemorrhage, and gastrointestinal haemorrhage. For full details of adverse reactions and contraindications, see the summary of product characteristics.

The manufacturer has stated that the cost per day for both doses (2.5 mg and 5 mg twice daily) of apixaban (excluding VAT) is £2.20, and the annual cost is £803. Costs may vary in different settings because of negotiated procurement discounts.