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Millions of Americans take anticoagulants to lower their risk of strokes and blood clots. Apixaban, sold under the brand name Eliquis, is one of the newer oral agents used for this purpose.

At the same time, dietary supplements are widely available without a prescription. Vitamin E is advertised for skin health, immunity, and heart benefits, and it shows up in many multivitamin formulations. In some cases, people take high-dose vitamin E because they believe it will reduce cardiovascular disease.

When you mix a prescription blood thinner with an over-the-counter supplement, there can be surprises. Many have asked whether it is safe to combine Eliquis with vitamin E. Below, we’ll explain how these two substances may interact and share practical tips to help reduce the risk of unwanted side effects.

Key Takeaways

  • Vitamin E is an essential fat-soluble nutrient, but high doses may interfere with normal blood clotting and reduce platelet clumping.
  • Research suggests that high vitamin E levels may increase bleeding risk, especially in people taking blood thinners. One meta-analysis found that vitamin E supplementation was associated with a 22% higher risk of hemorrhagic stroke.
  • Direct studies on vitamin E with Eliquis are limited, but surveys suggest many apixaban users unknowingly take supplements that may increase bleeding.
  • Low dietary intakes of vitamin E from food are safe, and multivitamins with small doses are usually not problematic. High-dose supplements (>400 IU/day) may increase bleeding risk.

What does vitamin E do in your body?

Vitamin E is a family of fat-soluble molecules called tocopherols and tocotrienols. It is best known as an antioxidant that helps neutralize free radicals that can damage cell membranes and DNA. Because it is fat-soluble, your body stores vitamin E in adipose tissue and the liver, making deficiency uncommon in people who eat a varied diet.

Recommended daily intake vs supplements

The body does not produce vitamin E, so we must obtain it through foods or supplements. The recommended dietary allowance (RDA) for adults is 15 mg (22 IU) per day, while lactating women need about 19 mg (28 IU).

Supplements vary widely. Many multivitamins contain modest doses (10 to 30 IU) of vitamin E. Stand-alone vitamin E capsules can range from 100 IU to 1,000 IU per capsule. Including vitamin E-rich foods in your diet is a safer way to meet nutritional needs than taking high doses of supplements. Foods with notable amounts include:

    • Nuts and seeds: Almonds, sunflower seeds, hazelnuts, and peanuts.
    • Vegetable oils: Wheat germ oil, sunflower oil, and safflower oil.
    • Green leafy vegetables: Spinach, Swiss chard, and broccoli.
    • Fortified cereals: Many breakfast cereals are fortified with vitamin E.
    • Avocado and mango: These fruits provide moderate amounts of vitamin E.

Eating a balanced diet that includes these foods offers vitamin E along with other beneficial nutrients and fiber.

Can vitamin E increase bleeding risk?

Yes. Several clinical observations support the idea that vitamin E can increase bleeding.

In a study of 566 patients with nonvalvular atrial fibrillation taking warfarin, 92 patients experienced bleeding events, including 15 major bleeds and 4 brain hemorrhages over an average follow-up of 22 months. Patients who bled had higher vitamin E levels than those who did not, and vitamin E levels tended to increase with bleeding severity.

More recently, a case report described a 31-year-old man who took 400 mg of vitamin E twice daily for 2 months along with non-steroidal anti-inflammatory drugs (NSAIDs) for his backache. Testing showed impaired blood clotting despite only slightly elevated vitamin E levels. Doctors concluded that vitamin E interfered with vitamin K-dependent clotting factors, leading to coagulopathy.

After stopping vitamin E and receiving vitamin K and supportive treatment, his symptoms and clotting tests returned to normal. The authors noted that even modest increases in vitamin E levels may raise bleeding risk, especially when combined with other medications that affect bleeding.

In larger studies, vitamin E was associated with a higher risk of hemorrhagic stroke, a type of bleeding in the brain. Specifically, vitamin E supplementation increased hemorrhagic stroke risk by 22%. This translates to about 1 additional hemorrhagic stroke per 1,250 people taking vitamin E.

How does vitamin E affect bleeding?

Even though vitamin E is essential, it has surprising effects on the body’s ability to clot blood.

Impact on vitamin K and clotting factors

Vitamin K is necessary for the liver to make clotting factors II, VII, IX, and X, as well as proteins C and S. Low levels of clotting factors II, VII, IX, and X can increase bleeding risk, while low levels of proteins C and S reduce the body’s natural ability to prevent excessive clotting, which can lead to dangerous blood clots.

Research shows that high-dose vitamin E supplements may interfere with vitamin K’s role in producing important clotting factors.

Adults who were not taking blood thinners were given 1,000 IU of vitamin E daily for 12 weeks. Results showed that levels of PIVKA-II, a marker that rises when vitamin K-dependent clotting activity is impaired, increased after supplementation. In one group, average PIVKA-II levels increased from 1.7 to 11.9 ng/mL, while in another they increased from 1.8 to 5.3 ng/mL.

Another study published in the Proceedings of the National Academy of Sciences found that regular vitamin E (alpha-tocopherol) has only mild blood-thinning effects, but a related form called vitamin E quinone may act as a much stronger anticoagulant. It can interfere with a vitamin K-dependent process that the body needs to form blood clots.

This may help explain why vitamin E has sometimes been linked to reduced risk of heart disease and stroke, but it also suggests that high amounts could potentially increase bleeding risk.

Additional work from the United States Department of Agriculture (USDA) on vitamin E and vitamin K interactions shows that high vitamin E intake reduces clotting factor activity in animals. In one trial, rats fed a diet rich in vitamin E developed increased bleeding that could be prevented by adding vitamin K.

Effects on platelet aggregation

Platelet aggregation is the process by which tiny blood cells, called platelets, clump together to form clots. Studies suggest that vitamin E can reduce platelet aggregation by affecting a signaling pathway called protein kinase C (PKC).

This effect appears to be separate from vitamin E’s antioxidant properties. Normally, when platelets are activated, PKC helps trigger changes that allow them to release clotting substances and stick together. Vitamin E may weaken this response, slowing platelet clumping.

While this could help reduce unwanted clot formation in some situations, it may also increase bleeding risk when combined with blood thinners like Eliquis.

Can you take vitamin E with Eliquis?

Vitamin E and Eliquis or apixaban bleeding risk

It is generally not recommended unless specifically advised by your doctor. Vitamin E can have anticoagulant properties, especially at high doses, while Eliquis or apixaban is already designed to reduce your blood’s clotting ability. Combining the two increases the risk of bleeding.

A survey of people taking apixaban found that nearly 90% were using at least one dietary supplement, and about 10% were taking vitamin E. The survey listed vitamin E alongside fish oil, flaxseed, melatonin, and ginseng as supplements that might increase bleeding risk.

Here are factors that you need to consider:

    • Your medical history: People with a history of gastrointestinal bleeding, hemorrhagic stroke, ulcers, or liver disease are already at increased risk on apixaban. Adding vitamin E could raise that risk further.
    • Other medications and supplements: Combining apixaban with aspirin, NSAIDs, fish oil, ginkgo biloba, ginseng, saw palmetto, or other natural products that thin the blood amplifies the risk of bleeding. Always review your medication list with a healthcare professional.
    • Reasons for supplementation: Ask yourself why you want to take vitamin E. If it is to improve skin or hair, you may find that a balanced diet meets your needs. If a doctor has advised high-dose vitamin E for a specific condition (for example, certain eye diseases or malabsorption syndromes), discuss the plan with them and weigh the benefits against the risks.

In many cases, it is prudent to avoid vitamin E supplements while taking Eliquis unless a healthcare provider specifically recommends them. Natural intake through food is generally safe and should not be restricted.

Safe use of supplements when on Eliquis

If you decide to use vitamin E or any supplement while on apixaban, do so deliberately and under supervision. Below are practical steps to stay safe.

Guidelines from research

Research and expert commentary suggest a few general rules:

    • Stay within the recommended dietary allowance: Aim for around 15 mg (22 IU) per day through diet or low-dose multivitamins. Avoid high-dose preparations unless specifically prescribed.
    • Be mindful of the upper limit: Do not exceed 1,000 mg (approximately 1,465 IU) per day. Even doses above 400 IU may increase bleeding risk, so the margin for safety is narrow.
    • Consider your total intake: Some fortified foods and multivitamins contain vitamin E. Add up all sources to ensure you are not inadvertently taking a high dose.

Signs and symptoms of excess bleeding

Being aware of bleeding signs can help you act promptly. Watch for:

    • Easy bruising: Bruises that appear without a clear cause or take a long time to heal.
    • Nosebleeds or gum bleeding: Occurring more often or lasting longer than usual.
    • Blood in urine or stool: Urine may look pink or red; stools may be black and tarry.
    • Persistent fatigue or weakness: This may signal anemia from internal bleeding.
    • Severe headache or sudden weakness: These could indicate an intracranial bleed and require emergency attention.

If you notice any of these symptoms, contact your physician or go to the emergency room. Do not stop taking Eliquis abruptly without medical advice, as that can increase the risk of clot formation.

How to talk to your healthcare team

Open communication with your doctor, nurse, or pharmacist is essential. Follow these tips:

    • Provide a complete list of supplements: Bring all bottles or a written list to appointments. Include herbal teas, essential oils, and dietary supplements.
    • Ask targeted questions: For example, “Is this dosage of vitamin E safe with my medication?” or “Are there safer alternatives for my goal?”
    • Discuss timing: If your doctor approves a low-dose supplement, ask whether it should be taken with food, at a specific time of day, or separated from other medications.
    • Schedule regular check-ups: Periodic blood tests may be needed to monitor kidney function and detect hidden bleeding. Although routine coagulation monitoring is not required for apixaban, your doctor may order complete blood counts or liver tests.

Alternative approaches to heart health

If you are taking vitamin E for heart health, consider evidence-based alternatives that do not increase bleeding risk:

    • Follow a heart-healthy diet: Emphasize fruits, vegetables, whole grains, lean proteins, and healthy fats such as olive oil and nuts. This naturally provides vitamin E without reaching dangerous levels.
    • Engage in regular physical activity: Aim for at least 150 minutes of moderate-intensity exercise per week as recommended by health authorities. Exercise helps maintain healthy blood vessels and reduces clotting tendency.
    • Quit smoking and limit alcohol: Smoking damages blood vessels and increases clotting risk. Excessive alcohol can also thin the blood unpredictably.
    • Manage blood pressure, cholesterol, and diabetes: Work with your healthcare team to keep these conditions under control. Doing so reduces the risk of both clots and bleeds.
    • Consider omega-3 fatty acids cautiously: Fish oil has modest benefits for triglycerides but may increase bleeding at high doses. Discuss the pros and cons with your doctor.
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Bottom line

Although research specifically on vitamin E and Eliquis is limited, experts generally recommend avoiding high-dose vitamin E supplements unless advised by a doctor. Research shows that vitamin E can slow blood clotting by interfering with vitamin K-dependent proteins and by hindering platelet aggregation. A growing body of evidence associates high vitamin E levels with bleeding events, including hemorrhagic strokes and prolonged bleeding in people taking anticoagulants.

If you take Eliquis and are considering supplements, talk with your healthcare provider first and watch for signs of unusual bleeding.

Frequently Asked Questions

Most multivitamins contain a small amount of vitamin E (often around 15 to 30 IU). At these low doses, vitamin E is unlikely to cause significant problems. However, you should still mention it to your doctor so they can consider the cumulative effect.

Certain medical situations, such as rare inherited vitamin E deficiency disorders or specific eye conditions, may require supplementation. If your specialist recommends vitamin E, discuss the dose and monitor for bleeding closely. They may adjust your Eliquis dose or ask you to have periodic lab tests.

True vitamin E deficiency is rare in healthy adults. It usually occurs in people with fat-malabsorption disorders (such as cystic fibrosis or short bowel syndrome) or genetic conditions that affect vitamin E transport. Symptoms include nerve damage, muscle weakness, and vision problems. Routine supplementation is not necessary for most people.

If you are taking high-dose vitamin E on your own and you start Eliquis, it is generally wise to stop the supplement unless a physician advises otherwise. Do not stop abruptly if your doctor prescribed it for a medical reason. Consult them first. Remember that vitamin E stored in fat tissue may take time to clear from your body.

The potential for additive bleeding effects exists with any anticoagulant. Rivaroxaban and dabigatran also carry warnings against combining with other agents that affect clotting. The research on vitamin E with these drugs is similarly limited, so the same cautious approach applies.

Vitamin C is generally considered safe to take with Eliquis, and no major interaction is known. Still, very high-dose supplements should be discussed with a healthcare provider, especially if you have kidney disease or take multiple medications.

Vitamin D is generally safe to take with Eliquis, and there is no well-established major interaction. Use the dose recommended by your doctor, especially if you are taking calcium or have kidney problems.

Turmeric or curcumin supplements should be used cautiously with Eliquis because they may affect platelet function and increase bleeding risk. Food-level turmeric in cooking is usually less concerning than concentrated supplements, but ask your doctor before taking turmeric capsules or extracts.

Related Articles

Sources

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