Eliquis, also known as apixaban, is an anticoagulant (blood thinner) used for several medical conditions. When taking any medication, it's essential to consider its potential side effects and associated risks. This is especially true with blood thinners.
This article reviews the possible side effects of Eliquis and how to mitigate some of the risks associated with its use. This will help improve patient safety and treatment outcomes.
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What is Eliquis?
Understanding Eliquis begins with exploring its mechanism of action, common uses, and benefits.
Mechanism of Action
Eliquis blocks factor Xa, acting as a direct factor Xa inhibitor. The medication is reversible and inhibits factor Xa, both free and bound to clots.
It also inhibits prothrombinase activity, which prevents clots from growing. Eliquis decreases thrombin generation and development of blood clots through its inhibition of factor Xa. Factor Xa is part of the clotting cascade that activates prothrombin.
Common Uses
Eliquis has several uses. These include:
- Prevention of strokes in patients with atrial fibrillation (AFib)
- Prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in people who recently had surgery
- Treatment of DVT or PE
There may be other potential uses for the medication not currently approved by the Food and Drug Administration (FDA). These are at the discretion of the healthcare provider.
Benefits and Considerations
Eliquis has a lower risk of bleeding and stroke compared to warfarin, according to a 2014 study that directly compared the two.
Warfarin is one of the most commonly used anticoagulants and predates newer agents. As such, it is frequently used for comparison testing.
Like other factor Xa inhibitors, Eliquis doesn't require regular monitoring with International Normalized Ratios (INR) testing, making it more convenient.
Common Side Effects of Eliquis
Like any medication, Eliquis can have side effects. There are several possible reactions that a person on Eliquis can develop.
Overview of Common Reactions
Some of the common reactions of Eliquis include:
- Minor bleeding, such as heavy menses, nosebleeds, bleeding gums, or easy bruising
- Fatigue
- Dizziness
- Rash
- Nausea
While these symptoms are often mild, discussing any side effects with your healthcare provider is critical to ensure proper management and safety.
Frequency and Duration of Side Effects
Studies on Eliquis showed that the incidence of minor bleeding was between 1% and 23.9%, depending on dosing. The incidence of all drug-related side effects was about 20.5% for Eliquis.
Self-Care Tips for Common Side Effects
Some common side effects of Eliquis can be managed with simple self-care tools.
- Dizziness can be managed by staying well-hydrated and moving more slowly, especially when changing positions.
- Mild rashes can be managed with antihistamine medications.
- Nausea can be managed by taking the medication after eating and avoiding rich or spicy foods.
Serious Side Effects and Risks
While the most common side effects of Eliquis are minor, there are still serious side effects that should be considered.
Recognizing Serious Side Effects
Serious side effects of Eliquis include severe bleeding, heavy bruising, and severe allergic reactions.
Allergic reactions generally cause hives, rashes, itching, or swelling of the face or tongue.
Bleeding becomes concerning if you are having bloody or black stools or if you are vomiting blood. Unexplained widespread bruising can also be concerning. In some cases, Eliquis can cause bleeding in the brain.
If you experience severe headaches, numbness or tingling, difficulty walking, confusion, or dizziness, you should seek immediate emergency care.
Bleeding Complications
The risk of severe bleeding with Eliquis was around 4.3% in studies. Several types of serious bleeding can occur with Eliquis.
Bleeding the GI Tract
Bleeding in the gastrointestinal tract can present with blood in the stool or vomiting blood, ranging from small amounts of blood in the stool to hemorrhages that can be life-threatening.
While bright red blood can be more pronounced, black tar-like stools can also indicate gastrointestinal bleeding. The presence of these symptoms is a reason to seek medical care.
Bleeding in the Brain
Brain bleeds are another very serious potential complication of Eliquis. Signs of brain bleeding include:
- Sudden severe headaches
- Seizures
- Loss of vision or blurring
- Numbness or tingling
Fatigue, weakness, and nausea can also be signs of a brain bleed. If these symptoms occur, they may indicate a medical emergency.
Bleeding in the spinal column can cause sudden weakness in the extremities and can even lead to paralysis.
Large, unexplained bruises or bruises that expand or grow can also be a sign of serious bleeding, which can lead to anemia, fatigue, and weakness.
Risk Factors for Serious Side Effects
The risk factors for serious bleeding include:
- Increasing age
- Previous history of bleeding
- Previous stroke or transient ischemic attack (TIA)
- Diabetes
- Impaired kidney function
- Use of certain medications such as aspirin or nonsteroidal anti-inflammatories (NSAIDs)
Other blood thinners and even some antidepressant medications may also increase the risk of bleeding.
Long-Term Side Effects of Eliquis
Long-term side effects of Eliquis are not common. The risks and side effects of Eliquis generally go away when the medication is stopped.
Potential Long-Term Risks
The most significant long-term risk of Eliquis and other anticoagulants is bleeding over time. Another risk is the risk of recurrent blood clots after stopping medication.
Of these risks, the risk of serious complications (including death) is higher with bleeding than with clots.
Monitoring and Preventative Care
Regular follow-up and preventative care are the best ways to avoid complications associated with Eliquis and other anticoagulants.
One advantage of Eliquis over therapies such as warfarin is that it doesn't require routine monitoring, like International Normalized Ratios (INR).
If monitoring of anticoagulant activity is necessary for patients on Eliquis, anti-Xa levels or Dilute Russell's viper venom time (DRVV-T) can be used.
Considerations for Special Populations
Eliquis is not recommended during pregnancy due to a lack of studies regarding safety and efficacy. If you are pregnant or planning to get pregnant, discussing these plans with your healthcare provider is important.
Eliquis is also not recommended during breastfeeding as Eliquis is secreted into the breastmilk.
The elderly, those with kidney disease or diabetes, and people with previous strokes and TIAs are at an increased risk for side effects and also for more serious complications associated with the side effects of Eliquis.
People on multiple medications are also at increased risk of interactions or side effects of medication.
Managing Side Effects Safely
Side effects of a medication don't automatically mean that a medication has to be discontinued. Some side effects, especially mild ones, can be managed.
Tips for Side Effect Prevention
Simple steps such as staying well hydrated and avoiding spicy or rich foods can help minimize some of the side effects associated with Eliquis. Moving more slowly for some position changes can also help offset dizziness.
Medication Interactions and Avoidance
Many medications can interact with Eliquis. Some of these include:
- Aspirin and similar medications
- Some antifungals
- Some anti-seizure medications
- Other blood thinners
- Some antibiotics
- Non-steroidal anti-inflammatory medications
- Some herbal supplements, such as St. John's wort
To avoid interactions, it's vitally important for your healthcare provider and your pharmacist to be aware of all medications you are taking, including supplements.
Communicating with Healthcare Providers
If you have questions or concerns about Eliquis or any medication, it's important to be open with your healthcare provider. They must know about all medications or supplements you are taking and any health conditions you may have.
When to Seek Emergency Care
Knowing when your symptoms warrant emergency attention is essential due to the potentially serious complications that can occur with Eliquis.
Red Flags for Urgent Intervention
Sudden or severe pain, as well as severe bleeding, are concerns that you may need emergency medical attention. Sudden weakness may also be a sign of an emergent medical condition.
Facial weakness, slurring of speech, or weakness on one side of the body could indicate bleeding in the brain.
Emergency Action Plan
If you suspect a serious complication associated with Eliquis use (or any medication), there are steps you can take.
- Notify your doctor or healthcare provider immediately if you have serious side effects.
- Call emergency services (9-1-1) for urgent transport to the nearest hospital if you have red-flag symptoms.
- If you feel weak or lightheaded, sit down and have someone stay with you until you are evaluated by a healthcare professional.
- If you are bleeding, apply pressure to the area if possible.
- Don't stop taking medications without the guidance of your healthcare provider.
Alternatives to Eliquis and Adjustments
Eliquis may not be the best option for everyone. Other anticoagulants can be used in some populations.
Overview of Alternative Medications
There are several alternatives to Eliquis for thinning blood. Some of these include:
- Pradaxa (dabigatran)
- Xarelto(rivaroxaban)
- Coumadin(warfarin)
- Plavix (clopidogrel)
- Aspirin
Each medication has different indications, side effects, and monitoring concerns. Your healthcare provider can help you determine which medication is best for you.
Switching or Adjusting Dosage
There are several choices when it comes to anticoagulants. Additional concerns may include the cost of the medication, other health conditions, and the frequency of monitoring. Before changing medication or doses, it's important to consult with your healthcare provider.
Frequently Asked Questions on Eliquis Side Effects
Here are some frequently asked questions (FAQs) on Eliquis.
Who shouldn't take Eliquis?
Eliquis is not recommended for people with artificial heart valves.
People with bleeding disorders, kidney or liver disease, stomach ulcers, pregnancy, or breastfeeding should consult with their healthcare provider.
How is the dose for Eliquis determined?
There are standard dosing recommendations for Eliquis.
How do I know if I should stop Eliquis?
Never stop a medication without consulting your healthcare provider.
How should Eliquis be taken?
Eliquis is generally taken twice a day, with or without food. It should be taken as directed by your healthcare provider.
What happens if I forget a dose?
Take it when you remember, but if it's time for the next dose, don't take two simultaneously.
Quick Tips for Side Effect Management
- Notify your healthcare provider if you experience any side effects.
- Seek emergency care for significant bleeding.
- Stay well hydrated.
- Avoid rich or spicy foods if Eliquis upsets your stomach.
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Key Takeaways
- Eliquis has the potential to cause serious side effects, including bleeding, nausea, fatigue, and allergic reactions.
- Some of these side effects have the potential to be serious or life-threatening. It is essential to recognize these side effects, know how to manage them, and when to seek emergency care.
- Your healthcare provider can help you determine whether Eliquis is the right choice for you.
- Communicating your medical history, any medications or supplements you may be taking, and any side effects you experience is important in helping you and your healthcare provider make the right treatment decisions.
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