Apixaban

Apixaban is indicated for the following:

• To lower the risk of stroke and systemic embolism in people with atrial fibrillation who have risk factors that may lead to a stroke.{{cite journal | vauthors = Kjerpeseth LJ, Selmer R, Ariansen I, Karlstad Ø, Ellekjær H, Skovlund E | title = Comparative effectiveness of warfarin, dabigatran, rivaroxaban and apixaban in non-valvular atrial fibrillation: A nationwide pharmacoepidemiological study | journal = PLOS ONE | volume = 14 | issue = 8 | pages = e0221500 | date = 2019 | pmid = 31449560 | pmc = 6709911 | doi = 10.1371/journal.pone.0221500 | doi-access = free | bibcode = 2019PLoSO..1421500K }}{{cite journal | vauthors = Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, Flaker G, Avezum A, Hohnloser SH, Diaz R, Talajic M, Zhu J, Pais P, Budaj A, Parkhomenko A, Jansky P, Commerford P, Tan RS, Sim KH, Lewis BS, Van Mieghem W, Lip GY, Kim JH, Lanas-Zanetti F, Gonzalez-Hermosillo A, Dans AL, Munawar M, O'Donnell M, Lawrence J, Lewis G, Afzal R, Yusuf S | title = Apixaban in patients with atrial fibrillation | journal = The New England Journal of Medicine | volume = 364 | issue = 9 | pages = 806–817 | date = March 2011 | pmid = 21309657 | doi = 10.1056/NEJMoa1007432 }}
• The prevention of Deep Vein Thrombosis (DVT) in patients who have undergone knee or hip replacement surgery.{{cite journal | vauthors = Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Hornick P | title = Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial | journal = Lancet | volume = 375 | issue = 9717 | pages = 807–815 | date = March 2010 | pmid = 20206776 | doi = 10.1016/S0140-6736(09)62125-5 }}{{cite journal | vauthors = Lassen MR, Gallus A, Raskob GE, Pineo G, Chen D, Ramirez LM | title = Apixaban versus enoxaparin for thromboprophylaxis after hip replacement | journal = The New England Journal of Medicine | volume = 363 | issue = 26 | pages = 2487–2498 | date = December 2010 | pmid = 21175312 | doi = 10.1056/NEJMoa1006885 }}
• Treatment of both DVT and PE.
• For extended treatment to reduce risk of recurring VTE after initial therapy in patients with high risk of recurrence, such as patients with active cancer or those with unprovoked VTE.{{Cite journal | vauthors = Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, Porcari A, Raskob GE, Weitz JI | title = Apixaban for Extended Treatment of Venous Thromboembolism | journal = The New England Journal of Medicine | volume = 368 | issue = 8 | pages = 699–708 | date = 2013-02-21 | pmid = 23216615 | doi = 10.1056/NEJMoa1207541 | url = http://www.nejm.org/doi/10.1056/NEJMoa1207541 | language = en | issn = 0028-4793 | hdl = 2445/178572 | hdl-access = free }}{{Cite journal | vauthors = Mahé I, Carrier M, Mayeur D, Chidiac J, Vicaut E, Falvo N, Sanchez O, Grange C, Monreal M, López-Núñez JJ, Otero-Candelera R, Le Gal G, Yeo E, Righini M, Robert-Ebadi H | title = Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism | journal = The New England Journal of Medicine | volume = 392 | issue = 14 | pages = 1363–1373 | date = 2025-04-10 | pmid = 40162636 | doi = 10.1056/NEJMoa2416112 | url = https://www.nejm.org/doi/10.1056/NEJMoa2416112 | language = en | issn = 0028-4793 }}{{Cite journal | vauthors = Couturaud F, Schmidt J, Sanchez O, Ballerie A, Sevestre MA, Meneveau N, Bertoletti L, Connault J, Benhamou Y, Constans J, Quemeneur T, Lapébie FX, Pernod G, Picart G, Elias A | title = Extended treatment of venous thromboembolism with reduced-dose versus full-dose direct oral anticoagulants in patients at high risk of recurrence: a non-inferiority, multicentre, randomised, open-label, blinded endpoint trial | journal = Lancet | location = London, England | volume = 405 | issue = 10480 | pages = 725–735 | date = March 2025 | pmid = 40023651 | doi = 10.1016/S0140-6736(24)02842-3 | language = en | doi-access = free }}{{Cite journal | vauthors = Tran HA, Gibbs H, Merriman E, Curnow JL, Young L, Bennett A, Tan CW, Chunilal SD, Ward CM, Baker R, Nandurkar H | title = New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism | journal = The Medical Journal of Australia | volume = 210 | issue = 5 | pages = 227–235 | date = March 2019 | pmid = 30739331 | doi = 10.5694/mja2.50004 | url = https://onlinelibrary.wiley.com/doi/abs/10.5694/mja2.50004 | language = en | issn = 0025-729X }}{{Cite journal | vauthors = Stevens SM, Woller SC, Baumann Kreuziger L, Doerschug K, Geersing GJ, Klok FA, King CS, Murin S, Vintch JR, Wells PS, Wasan S, Moores LK | title = Antithrombotic Therapy for VTE Disease | journal = Chest | volume = 166 | issue = 2 | pages = 388–404 | date = August 2024 | pmid = 38458430 | doi = 10.1016/j.chest.2024.03.003 | language = en | doi-access = free }}{{Cite journal | vauthors = Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, ten Cate-Hoek AJ, Elalamy I, Enzmann FK, Geroulakos G, Gottsäter A, Hunt BJ, Mansilha A, Nicolaides AN, Sandset PM | title = Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis | journal = European Journal of Vascular and Endovascular Surgery| volume = 61 | issue = 1 | pages = 9–82 | date = January 2021 | pmid = 33334670 | doi = 10.1016/j.ejvs.2020.09.023 | url = https://linkinghub.elsevier.com/retrieve/pii/S1078588420308686 | language = en | hdl = 10362/147427 | hdl-access = free }}

In the EU, apixaban is indicated for the prevention of venous thromboembolic events (VTE) in adults who have undergone elective hip or knee replacement surgery, the prevention of stroke and systemic embolism in adults with non-valvular atrial fibrillation (NVAF) with one or more risk factors, for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in adults, and for the prevention of recurrent DVT and PE in adults.

Apixaban is recommended by the National Institute for Health and Clinical Excellence for the prevention of stroke and systemic embolism in people with atrial fibrillation and a CHA2DS2-VASc score ≥ 2. Apixaban may also be considered for men with a CHA2DS2-VASc of 1 after accounting for bleeding risk{{cite web |date=January 2021 |title=Atrial fibrillation: diagnosis and management |url=https://www.nice.org.uk/guidance/ng196/resources/atrial-fibrillation-diagnosis-and-management-pdf-66142085507269 |access-date= |publisher=National Institute for Health and Care Excellence |format=PDF}}{{Cite journal | vauthors = Joundi RA, Cipriano LE, Sposato LA, Saposnik G | collaboration = on behalf of the Stroke Outcomes Research Working Group | title = Ischemic Stroke Risk in Patients With Atrial Fibrillation and CHA 2 DS 2 -VASc Score of 1: Systematic Review and Meta-Analysis | journal = Stroke | volume = 47 | issue = 5 | pages = 1364–1367 | date = May 2016 | pmid = 27026630 | doi = 10.1161/STROKEAHA.115.012609 | url = https://www.ahajournals.org/doi/10.1161/STROKEAHA.115.012609 | language = en | issn = 0039-2499 }}{{Cite journal | vauthors = Lopes RD, Al-Khatib SM, Wallentin L, Yang H, Ansell J, Bahit MC, De Caterina R, Dorian P, Easton JD, Erol C, Ezekowitz JA, Gersh BJ, Granger CB, Hohnloser SH, Horowitz J | title = Efficacy and safety of apixaban compared with warfarin according to patient risk of stroke and of bleeding in atrial fibrillation: a secondary analysis of a randomised controlled trial | journal = Lancet | location = London, England | volume = 380 | issue = 9855 | pages = 1749–1758 | date = November 2012 | pmid = 23036896 | doi = 10.1016/S0140-6736(12)60986-6 | url = https://linkinghub.elsevier.com/retrieve/pii/S0140673612609866 | language = en }}

Apixaban and other direct oral anticoagulants (DOACs) (dabigatran, edoxaban and rivaroxaban) are at least as effective as warfarin in preventing stroke or systemic embolism in people with atrial fibrillation not caused by moderate-to-severe mitral stenosis or mechanical heart valves.{{cite journal | vauthors = Lowenstern A, Al-Khatib SM, Sharan L, Chatterjee R, Allen LaPointe NM, Shah B, Borre ED, Raitz G, Goode A, Yapa R, Davis JK, Lallinger K, Schmidt R, Kosinski AS, Sanders GD | title = Interventions for Preventing Thromboembolic Events in Patients With Atrial Fibrillation: A Systematic Review | journal = Annals of Internal Medicine | volume = 169 | issue = 11 | pages = 774–787 | date = December 2018 | pmid = 30383133 | pmc = 6825839 | doi = 10.7326/M18-1523 }}{{cite journal | vauthors = Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L | title = Apixaban versus warfarin in patients with atrial fibrillation | journal = The New England Journal of Medicine | volume = 365 | issue = 11 | pages = 981–992 | date = September 2011 | pmid = 21870978 | doi = 10.1056/NEJMoa1107039 }}{{cite journal | vauthors = Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L | title = Dabigatran versus warfarin in patients with atrial fibrillation | journal = The New England Journal of Medicine | volume = 361 | issue = 12 | pages = 1139–1151 | date = September 2009 | pmid = 19717844 | doi = 10.1056/NEJMoa0905561 | hdl = 11343/221723 | hdl-access = free }}{{cite journal | vauthors = Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM | title = Rivaroxaban versus warfarin in nonvalvular atrial fibrillation | journal = The New England Journal of Medicine | volume = 365 | issue = 10 | pages = 883–891 | date = September 2011 | pmid = 21830957 | pmc = 3860773 | doi = 10.1056/NEJMoa1009638 }} Compared to warfarin, DOACs are associated with a significantly lower risk of intracranial hemorrhage, with apixaban demonstrating both superior efficacy and safety.

While data are limited for the use of apixaban in people with severely decreased kidney function and those on hemodialysis, studies are investigating its potential as an alternative to standard therapy, vitamin K antagonists. However, optimal dosing in these populations is yet to be determined.{{cite journal | vauthors = Hohnloser SH, Hijazi Z, Thomas L, Alexander JH, Amerena J, Hanna M, Keltai M, Lanas F, Lopes RD, Lopez-Sendon J, Granger CB, Wallentin L | title = Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial | journal = European Heart Journal | volume = 33 | issue = 22 | pages = 2821–2830 | date = November 2012 | pmid = 22933567 | doi = 10.1093/eurheartj/ehs274 }}

Bleeding is a known side effect of apixaban.{{Cite journal | vauthors = Fernandez S, Lenoir C, Samer C, Rollason V | title = Drug interactions with apixaban: A systematic review of the literature and an analysis of VigiBase, the World Health Organization database of spontaneous safety reports | journal = Pharmacology Research & Perspectives | volume = 8 | issue = 5 | pages = e00647 | date = October 2020 | pmid = 32881416 | pmc = 7507549 | doi = 10.1002/prp2.647 | language = en | issn = 2052-1707 }} The likelihood of bleeding increases when it is combined with other medications that affect blood clotting, such as anticoagulants, aspirin, antiplatelet medications, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and nonsteroidal anti-inflammatory drugs (NSAIDs).{{Cite journal | vauthors = Jaspers Focks J, Brouwer MA, Wojdyla DM, Thomas L, Lopes RD, Washam JB, Lanas F, Xavier D, Husted S, Wallentin L, Alexander JH, Granger CB, Verheugt FW | title = Polypharmacy and effects of apixaban versus warfarin in patients with atrial fibrillation: post hoc analysis of the ARISTOTLE trial | journal = BMJ | location = Clinical Research Ed. | volume = 353 | pages = i2868 | date = 2016-06-15 | pmid = 27306620 | pmc = 4908974 | doi = 10.1136/bmj.i2868 | language = en | issn = 1756-1833 }}{{Cite journal | vauthors = Alexander JH, Lopes RD, James S, Kilaru R, He Y, Mohan P, Bhatt DL, Goodman S, Verheugt FW, Flather M, Huber K, Liaw D, Husted SE, Lopez-Sendon J, De Caterina R | title = Apixaban with Antiplatelet Therapy after Acute Coronary Syndrome | journal = The New England Journal of Medicine | volume = 365 | issue = 8 | pages = 699–708 | date = 2011-08-25 | pmid = 21780946 | doi = 10.1056/NEJMoa1105819 | url = http://www.nejm.org/doi/10.1056/NEJMoa1105819 | language = en | issn = 0028-4793 | hdl = 2066/95648 | hdl-access = free }}{{Cite journal | vauthors = Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, Flaker G, Avezum A, Hohnloser SH, Diaz R, Talajic M, Zhu J, Pais P, Budaj A, Parkhomenko A | title = Apixaban in Patients with Atrial Fibrillation | journal = The New England Journal of Medicine | volume = 364 | issue = 9 | pages = 806–817 | date = 2011-03-03 | pmid = 21309657 | doi = 10.1056/NEJMoa1007432 | url = https://www.nejm.org/doi/full/10.1056/NEJMoa1007432 | language = en | issn = 0028-4793 }}{{Cite journal | vauthors = Chang KH, Chen CM, Wang CL, Tu HT, Huang YT, Wu HC, Chang CH, Chang SH | title = Major Bleeding Risk in Patients With Non-valvular Atrial Fibrillation Concurrently Taking Direct Oral Anticoagulants and Antidepressants | journal = Frontiers in Aging Neuroscience | volume = 14 | pages = 791285 | date = 2022-02-04 | pmid = 35185526 | pmc = 8855103 | doi = 10.3389/fnagi.2022.791285 | doi-access = free | issn = 1663-4365 }}{{Cite journal | vauthors = Rahman AA, Platt RW, Beradid S, Boivin JF, Rej S, Renoux C | title = Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding | journal = JAMA Network Open | volume = 7 | issue = 3 | pages = e243208 | date = 2024-03-22 | pmid = 38517440 | pmc = 10960200 | doi = 10.1001/jamanetworkopen.2024.3208 | language = en | issn = 2574-3805 }} Large clinical trials, including the ARISTOTLE trial, have shown that these combinations can modestly raise the risk of major bleeding. In clinical practice, healthcare providers carefully assess each patient's individual risk to ensure apixaban is used safely and effectively.

Andexanet alfa is a US Food and Drug Administration (FDA) approved antidote for apixaban in people with uncontrolled and life-threatening bleeding events.{{cite web | title = Andexxa- andexanet alfa injection, powder, lyophilized, for solution | date = 8 January 2019 | website = DailyMed | url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ae7f0c50-ff2d-49e5-8e10-4efa861556e6 | access-date = 23 December 2019 }}{{cite web | title = Andexxa (coagulation factor Xa (recombinant), inactivated-zhzo) | date = 31 December 2018 | website = U.S. Food and Drug Administration (FDA) | url = https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/andexxa-coagulation-factor-xa-recombinant-inactivated-zhzo | archive-url = https://web.archive.org/web/20200529220210/https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/andexxa-coagulation-factor-xa-recombinant-inactivated-zhzo | url-status = dead | archive-date = 29 May 2020 | access-date = 22 April 2020 }}

Following spinal anesthesia or puncture, people who are being treated with anti-thrombotic agents are at higher risk for developing a hematoma, which causes long-term or permanent paralysis. The risk of this may be increased by using epidural or intrathecal catheters after a surgical operation or from the concurrent use of medicinal agents that affect hemostasis.

Apixaban is a highly selective, orally bioavailable, and reversible direct inhibitor of free and clot-bound factor Xa. Factor Xa catalyzes the conversion of prothrombin to thrombin, the final enzyme in the coagulation cascade that is responsible for fibrin clot formation.{{cite journal | vauthors = Frost C, Wang J, Nepal S, Schuster A, Barrett YC, Mosqueda-Garcia R, Reeves RA, LaCreta F | title = Apixaban, an oral, direct factor Xa inhibitor: single dose safety, pharmacokinetics, pharmacodynamics and food effect in healthy subjects | journal = British Journal of Clinical Pharmacology | volume = 75 | issue = 2 | pages = 476–487 | date = February 2013 | pmid = 22759198 | pmc = 3558798 | doi = 10.1111/j.1365-2125.2012.04369.x }} Apixaban has no direct effect on platelet aggregation, but by inhibiting factor Xa, it indirectly decreases clot formation induced by thrombin.{{cite web | title = Eliquis- apixaban tablet, film coated Eliquis 30-day starter pack- apixaban kit | date = 26 November 2019 | website = DailyMed | url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e9481622-7cc6-418a-acb6-c5450daae9b0 | access-date = 22 April 2020 }}

Apixaban was approved for medical use in the European Union in May 2011.

A new drug application (NDA) for the approval of apixaban was submitted to the US Food and Drug Administration (FDA) by Bristol-Myers Squibb (BMS) and Pfizer jointly after the conclusion of the ARISTOTLE clinical trial in 2011.{{cite journal | vauthors = Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L | title = Apixaban versus warfarin in patients with atrial fibrillation | journal = The New England Journal of Medicine | volume = 365 | issue = 11 | pages = 981–992 | date = September 2011 | pmid = 21870978 | doi = 10.1056/NEJMoa1107039 | s2cid = 43262809 | doi-access = free }} Apixaban was approved for the prevention of stroke in people with atrial fibrillation in December 2012.{{cite journal | vauthors = Cada DJ, Levien TL, Baker DE | title = Apixaban | journal = Hospital Pharmacy | volume = 48 | issue = 6 | pages = 494–509 | date = June 2013 | pmid = 24421512 | pmc = 3839491 | doi = 10.1310/hpj4806-494 }} In March 2014, it was approved for the additional indication of preventing deep vein thrombosis and pulmonary embolism in people who have recently undergone knee or hip replacement.{{cite web | title = FDA-Approved Drugs: Eliquis (apixaban) | url = https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=202155 | archive-url = https://web.archive.org/web/20170217085705/http://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=202155 | url-status = dead | archive-date = 17 February 2017 | access-date = 23 December 2019 | website = U.S. Food and Drug Administration (FDA) }}{{cite news | vauthors = Neale T | title = FDA OKs Apixaban for DVT Prevention | date = 14 March 2014 | agency = MedPage Today | url = http://www.medpagetoday.com/Cardiology/VenousThrombosis/44776 | access-date = 17 September 2015 }} In August 2014, the FDA approved apixaban for the additional indication of the treatment of recurring deep vein thrombosis and pulmonary embolism.{{cite press release | title = U.S. FDA Approves Eliquis (apixaban) for the Treatment of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), and for the Reduction in the Risk of Recurrent DVT and PE Following Initial Therapy | date = 21 August 2014 | url = http://www.pfizer.com/news/press-release/press-release-detail/u_s_fda_approves_eliquis_apixaban_for_the_treatment_of_deep_vein_thrombosis_dvt_and_pulmonary_embolism_pe_and_for_the_reduction_in_the_risk_of_recurrent_dvt_and_pe_following_initial_therapy | publisher = Pfizer | access-date = 26 February 2016 }} During its development the drug was known as BMS-562247-01.{{cite web | title = Apixaban | date = 27 August 2022 | url = https://pubchem.ncbi.nlm.nih.gov/compound/Apixaban | access-date = 2 September 2022 | publisher = PubChem, US National Library of Medicine }} By late 2019, sales of the product by BMS accounted for thirty percent of their quarterly revenue.{{cite news | title = FIRST: Mylan, Micro Labs get USFDA nod for generic version of blood thinner Eliquis | location = New Delhi, India | date = 24 December 2019 | work = Business Medical Dialogues | publisher = Minerva Medical Treatment | url = https://business.medicaldialogues.in/first-mylan-micro-labs-get-usfda-nod-for-generic-version-of-blood-thinner-eliquis/ | access-date = 24 December 2019 }}

In December 2019, the US FDA approved a generic version of apixaban produced jointly by Mylan and Micro Labs.{{cite web | title = 2019 First Generic Drugs Approvals | date = 5 August 2020 | website = U.S. Food and Drug Administration (FDA) | url = https://www.fda.gov/drugs/first-generic-drug-approvals/2019-first-generic-drug-approvals | archive-url = https://web.archive.org/web/20230630003606/https://www.fda.gov/drugs/first-generic-drug-approvals/2019-first-generic-drug-approvals | archive-date = 30 June 2023 | url-status = dead | access-date = 30 June 2023 }} BMS and Pfizer worked quickly to block generics from being created, and in August 2020, they won a patent infringement lawsuit against Sigmapharm, Sunshine Lake, and Unichem, after previously settling patent cases against 25 other companies.{{cite web | title = Bristol-Myers Squibb Co. v. Aurobindo Pharma USA Inc. | url = https://www.jdsupra.com/legalnews/bristol-myers-squibb-co-v-aurobindo-70530/ | access-date = 30 November 2021 | website = JD Supra }}{{cite web | title = Bristol Myers, Pfizer fend off a key challenge to their top-selling heart drug | url = https://www.biopharmadive.com/news/bristol-myers-pfizer-eliquis-patent-court-ruling/583027/ | access-date = 30 November 2021 | website = BioPharma Dive }} In September 2021, a Federal Circuit Court upheld the ruling.{{cite web | title = Federal Circuit Crystallizes BMS' Apixaban District Court Win | url = https://www.natlawreview.com/article/federal-circuit-crystallizes-bms-apixaban-district-court-win | access-date = 30 November 2021 | website = The National Law Review }} The result is that apixaban generics will most likely not be available in the United States until at least 2026, but possibly 2031.

In July 2022, the Canadian generic drug company, Apotex Inc., obtained approval for marketing of apixaban.{{cite web | vauthors = Levy S | title = Apotex offers generic Eliquis in Canada | date = 1 August 2022 | url = https://drugstorenews.com/apotex-offers-generic-eliquis-canada | publisher = Drugstore News | access-date = 2 September 2022 }}{{cite press release | title = First Generic Alternative to Eliquis Now Available in Canada | date = 20 July 2022 | website = Apotex | url = https://www.apotex.com/global/about-us/press-center/2022/07/20/first-generic-alternative-to-eliquis-now-available-in-canada | access-date = 29 June 2023 }}

Pfizer reported revenue of {{US$|6.747 billion}} for Eliquis in 2023.{{cite web | title = Pfizer's year in review | date = 31 December 2023 | website = Pfizer 2023 Annual Report | url = https://www.pfizer.com/sites/default/files/investors/financial_reports/annual_reports/2023/ | access-date = 30 December 2024 }}

Apixaban is one of ten medications covered by price negotiations in the US under the Inflation Reduction Act. The negotiations, conducted by the Centers for Medicare & Medicaid Services, apply to pricing for Medicare recipients. The results of the negotiations were announced in August 2024, and Medicare's negotiated price for a 30-day supply of Eliquis is $231, a 56% decrease from the 2023 list price of $521.{{cite web | title = Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026 | date = 15 August 2024 | website = CMS | url = https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price-negotiation-program-negotiated-prices-initial-price-applicability-year-2026 | access-date = 30 December 2024 }} The pricing is set to take effect in 2026.{{Cite web | vauthors = Lovelace Jr B | title = Medicare announces lower prices on 10 common, high-cost drugs | date = 15 August 2024 | url = https://www.nbcnews.com/health/health-news/medicare-cost-lower-medication-diabetes-blood-thinners-rcna166385 | access-date = 21 August 2024 | website = NBC News }}{{Cite web | title = Medicare Drug Price Negotiation Program: Medicare Prices Negotiated for 2026 Compared to List and U.S. Market Prices | date = 15 August 2024 | url = https://aspe.hhs.gov/sites/default/files/documents/3e8abec86039ac0ed674a8c5fac492e3/price-change-over-time-brief.pdf | publisher = Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services }}

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