Apixaban (Eliquis): Superior anticoagulation efficacy with minimized bleeding risks

With its non-inferior efficacy and favorable safety profile backed by extensive clinical trial evidence, together with its ease of use compared to warfarin, direct oral anticoagulants (DOACs) like apixaban (Eliquis) have become central in anticoagulation therapy.^1-3 However, data comparing the different DOACs had been coming from small, observational studies that showed mixed results.² While current guidelines now recommend the use of DOACs in preference to warfarin, guidance on which DOAC to use had been anecdotal provider experience.³ This was until the results of the study that did a head-to-head comparison of the various DOACs including apixaban, dabigatran, edoxaban and rivaroxaban, provided a deeper perspective.

The landmark CORAZON study covered electronic health databases that covered different points of care in 4 countries. It also included older patients (aged 80 years old or more) and those diagnosed with chronic kidney disease. These populations are often under-represented in clinical trials. The study compared the effects of standard dose of different DOACs on the composite of stroke and systemic embolism, intracranial hemorrhage, gastrointestinal (GI) bleeding and all-cause mortality.³

 Study results

At its conclusion, the study was able to review longitudinal health records of over half a million patients and it clearly showed that apixaban has a significantly lower risk of GI bleeding compared to dabigatran, edoxaban and rivaroxaban. Similar risk was noted across the different DOACs for the composite of stroke and systemic embolism, and intracranial hemorrhage, and all-cause mortality (Figure 1).³


Figure 1. Comparison of risks of stroke/systemic embolism, bleeding all-cause mortality of Apixaban with other DOACs.
^{Adapted from Lau WCY et al. 2022}

The study’s findings demonstrate that apixaban is associated with a significantly lower risk of GI bleeding than the other agents, reinforcing its role as a safer option for patients at high bleeding risk, such as the elderly or those with prior GI issues. This is also especially relevant for patients requiring long-term anticoagulation.³

Notably, the study complemented clinical trial results where the efficacy of apixaban in preventing stroke and systemic embolism remained at par with the standards of care. This balance of reduced bleeding risk without compromising anticoagulant effectiveness strengthens the case for its use in clinical practice.³

 Conclusion

Data from both clinical trials and real-world study has been consistent in demonstrating the safety of apixaban compared to warfarin and other DOACs, especially in terms of reduction of risk of GI bleeding, while maintaining its efficacy in anticoagulation to prevent strokes and systemic embolism.^1-3 The complementarity and consistency of the results across different study settings provide clinicians with a strong evidence base to make informed therapeutic decisions and tailor anticoagulation therapy to patient needs, thereby optimize outcomes while minimizing risks.