What is Eliquis, and How Does it Work

Eliquis (apixaban) is a prescription blood thinner medication that belongs to the drug class called direct oral anticoagulants (DOACs). Unlike older blood thinners like warfarin, Eliquis works by directly targeting and blocking factor Xa, a crucial protein in the blood clotting process. This targeted approach reduces the likelihood of blood forming dangerous clots while offering several advantages over traditional anticoagulant therapy, such as warfarin.

Healthcare providers commonly prescribe Eliquis for patients with atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism, or those at high risk for stroke prevention. The medication has gained popularity among doctors and patients because it doesn't require frequent blood monitoring like warfarin, has fewer food and drug interactions, and generally causes fewer bleeding complications.

Common Eliquis Side Effects: What Patients Need to Know

1. Minor Bleeding - The Most Frequent Side Effect

The most common side effect patients experience while taking Eliquis is minor bleeding. This can manifest as nosebleeds, bleeding gums during tooth brushing, heavier menstrual periods than usual, or bruising more easily than normal. Many patients notice that small cuts take longer to stop bleeding, which is expected when taking any anticoagulant medication.

To manage minor bleeding while on Eliquis, patients should always carry bandages, use a soft-bristled toothbrush, and inform healthcare providers about their medication before any procedures, including vaccinations. Creating a safe home environment by removing trip hazards can help prevent falls and subsequent bleeding incidents. If you do bleed, and it doesn’t stop on its own, or you are concerned about how heavy your menstrual periods are, ring your healthcare provider, or go to the emergency department if the bleeding is severe.

2. Serious Bleeding Complications

While severe bleeding affects fewer than 3% of Eliquis users, it represents the most dangerous potential side effect. Patients should immediately seek emergency medical attention if they experience blood in vomit or cough (which may appear like coffee grounds), pink or brown-colored urine, black or red tarry stools, or bleeding that won't stop.

Brain bleeding symptoms include sudden severe headache, dizziness, vision changes, difficulty speaking, or facial drooping - all signs of a potential stroke.

Call 911 if you experience any of these signs of severe bleeding. If the bleeding is caused by Eliquis, an antidote called andexanet alfa is available in emergencies to counteract the medication's blood-thinning effects, so you must seek help quickly.

Tell all your healthcare providers that you are taking Eliquis. Eliquis may need to be temporarily stopped at least 48 hours before surgery, which has a moderate-to-high risk of significant bleeding, or 24 hours before surgery with a low risk of bleeding. Eliquis should be restarted once the risk of bleeding following surgery has returned to normal.

3. Nausea and Digestive Issues

Approximately 3% of patients taking Eliquis report experiencing nausea or feeling sick to their stomach. Taking the medication with food or a light snack often helps reduce these symptoms. However, persistent nausea should be reported to a healthcare provider, as it can sometimes indicate internal bleeding.

Patients should avoid excessive amounts of ginger, despite its anti-nausea properties, because it can increase bleeding risk when combined with Eliquis.

Serious but Rare Eliquis Side Effects

4. Spinal Blood Clots (Epidural Hematoma)

Patients taking Eliquis who undergo spinal procedures like epidurals, lumbar punctures, or spinal surgery face an increased risk of developing spinal blood clots. This complication can lead to permanent paralysis, making it crucial for patients to inform all healthcare providers about their Eliquis use before any spinal procedure. Healthcare providers typically stop Eliquis 24-48 hours before spinal procedures and restart it once bleeding risk returns to normal.

Risk factors for spinal hematoma include taking additional blood-thinning medications like aspirin or NSAIDs, having a history of spinal procedures, or spinal abnormalities. Symptoms of a spinal blood clot include numbness, tingling, or weakness in the lower back or legs. If you experience any of these symptoms, especially after a spinal procedure, contact your healthcare provider urgently.

5. Liver Problems and Elevated Enzymes

Less than 1% of Eliquis users experience liver-related side effects, including elevated liver enzymes or mild liver injury. These problems typically occur within days of starting the medication and resolve quickly after discontinuation.

Warning signs of liver problems include yellowing of skin or eyes (jaundice), abdominal pain and swelling, dark urine, leg swelling, itchy skin, nausea, vomiting, or unusual fatigue. Patients experiencing these symptoms should contact their healthcare provider immediately.

6. Eliquis Discontinuation and Blood Clot Risk

One of the most important aspects of Eliquis therapy is understanding the risks associated with stopping the medication. Suddenly discontinuing Eliquis can lead to rebound blood clot formation, potentially causing heart attack, stroke, or pulmonary embolism.

Healthcare providers determine treatment duration based on individual patient factors - some patients take Eliquis for just a few months, while others require lifelong therapy. Patients should never stop taking Eliquis without medical supervision, even if they're experiencing side effects.

Signs of blood clot formation after stopping Eliquis include swelling, pain, or redness in arms or legs, coughing up blood, chest pain, shortness of breath, irregular heartbeat, or severe headaches. These symptoms require immediate medical attention.

Eliquis vs Warfarin: Why Doctors Prefer DOACs

Compared to warfarin, Eliquis offers several advantages that make it a preferred choice for many patients and healthcare providers. Eliquis doesn't require regular blood tests (INR monitoring), has fewer interactions with food and other medications, and statistically causes fewer major bleeding complications.

The convenience factor cannot be overstated - patients on warfarin must have frequent blood draws and dietary restrictions, while Eliquis users can maintain more normal lifestyles while receiving effective anticoagulation therapy.

Surgery and Medical Procedures While Taking Eliquis

Patients scheduled for surgery or medical procedures with bleeding risk need careful Eliquis management. Healthcare providers typically stop the medication 24 hours before low-bleeding-risk procedures or 48 hours before moderate-to-high-risk surgeries.

The timing of restarting Eliquis depends on the procedure and individual bleeding risk factors. Patients should always inform all healthcare providers, including dentists and specialists, about their Eliquis use before any treatment.

Managing Eliquis Side Effects: Patient Tips

Successful Eliquis therapy involves understanding how to manage potential side effects while maintaining medication adherence. Patients should establish good communication with their healthcare team, report any concerning symptoms promptly, and understand the balance between bleeding risk and clot prevention.

Regular follow-up appointments allow healthcare providers to monitor treatment effectiveness and adjust therapy as needed. Patients should also maintain a medication list and wear medical alert jewelry indicating their use of anticoagulant medication.

When to Contact Your Healthcare Provider

Patients taking Eliquis should contact their healthcare provider immediately for severe bleeding, signs of stroke, symptoms of liver problems, or any unexplained symptoms that develop after starting the medication. For life-threatening emergencies, calling 911 ensures access to appropriate reversal agents and emergency care.

For more information on Eliquis see Eliquis: 7 things you should know

References

• Agrawal A, Manna B. Apixaban. [Updated 2024 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507910/
• LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Apixaban. [Updated 2023 Feb 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548281/
• Eliquis Package Insert. Drugs.com. https://www.drugs.com/eliquis.html

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