Eliquis Side Effects: Risks, Management & Safety Tips

Eliquis (apixaban) is a commonly prescribed anticoagulant (blood thinner) used to prevent blood clots and reduce the risk of stroke in individuals with certain conditions. While Eliquis is highly effective, it also carries potential side effects, particularly due to its effect on blood clotting.

Clinical trials indicate that 1.5% to 1.7% of participants discontinued Eliquis due to side effects. These numbers may appear small, but they reflect a significant challenge for those affected and raise important questions about how to safely manage treatment.

Knowing the possible side effects, understanding how to manage them, and taking appropriate safety measures are essential for those on this medication. This guide provides an in-depth look into Eliquis side effects, associated risks, management strategies, and safety recommendations.

How Eliquis Works

Eliquis works by inhibiting Factor Xa, a key protein in the blood-clotting process. By blocking this protein, Eliquis prevents clots from forming, reducing the risk of complications like stroke or pulmonary embolism. Unlike older anticoagulants such as warfarin, Eliquis does not require frequent blood tests or strict dietary restrictions, making it more convenient for many patients.

What Eliquis Is Used For

Doctors commonly prescribe Eliquis to:

• • Prevent strokes in patients with non-valvular atrial fibrillation
  • Treat and prevent blood clots in conditions like deep vein thrombosis (DVT) and pulmonary embolism (PE)
  • Reduce the risk of recurrent DVT or PE

Fun Fact!

The first blood thinner, warfarin, was initially marketed as a rat poison in 1948. In 1951, a US Army recruit attempted suicide by ingesting large amounts of warfarin-based rodenticide but was successfully treated with vitamin K at the hospital. This incident sparked interest in warfarin as a potential anticoagulant for medical use, leading to its approval for human treatment in 1954.

Common Side Effects of Eliquis

Minor bleeding episodes were the most common side effect of Eliquis, often classified as clinically relevant non-major bleeding (CRNMB) because they may require medical attention but are typically not life-threatening or serious. These types included:

• • Contusion (bruising)
  • Hematuria (blood in the urine)
  • Menorrhagia (heavy menstrual bleeding)
  • Hematoma (large bruise or blood pooling)
  • Hemoptysis (coughing up blood)
  • Rectal hemorrhage (bleeding from the rectum)
  • Gingival bleeding (gum bleeding)

It’s still important to contact your doctor if you experience any bleeding. These events can sometimes indicate that your body is more sensitive to Eliquis, or they could signal a risk of more severe bleeding in the future.

Your doctor may evaluate the bleeding’s severity and decide if any medication adjustments are necessary. They can also review any risk factors that might increase bleeding, such as other medications or underlying health conditions.

Serious Side Effects of Eliquis

The serious side effects of Eliquis primarily involve:

1. Major Bleeding

This includes severe bleeding that can occur in critical areas, such as:

• • Gastrointestinal bleeding: Refers to bleeding anywhere along the gastrointestinal tract, from the esophagus to the rectum. It can be classified as upper or lower GI bleeding based on the location. Common signs of GI bleeding include:

• • • blood in the stool
    • vomiting blood
    • bleeding from hemorrhoids
    • black, tarry stools with a strong odor

• • Intracranial bleeding: Refers to bleeding within the brain or skull. Symptoms may include:

• • • sudden, severe headache
    • confusion
    • vision changes
    • weakness
    • loss of consciousness

Some people taking Eliquis have reported experiencing dizziness and confusion, which may be more common in older adults. The exact cause of these side effects is unclear.

• • Intraspinal bleeding: Bleeding within the spinal cord or around it. Eliquis carries a boxed warning about this possibility. Such bleeding can lead to paralysis in certain parts of the body, depending on where the bleed occurs.

Seek medical care right away if you experience:

• • • numbness or loss of sensation in specific areas, often starting in the legs or arms
    • weakness or difficulty moving certain body parts
    • back pain that may be sudden and severe
    • loss of bladder or bowel control if the bleed affects areas controlling these functions
    • tingling or pins-and-needles sensation in the limbs

• • Intraocular bleeding: Bleeding within the eye, which can result in vision changes, eye pain, or even loss of vision. It may cause a visible red or dark spot in the eye and requires prompt care to prevent permanent eye damage.

• • Pericardial bleeding: Bleeding around the heart, specifically within the pericardial sac–a thin, double-layered membrane that surrounds the heart. This can lead to symptoms like:

• • • chest pain
    • difficulty breathing
    • signs of heart compression

• • Bleeding in an operated joint: This refers to significant bleeding in a previously operated joint, which may cause pain, swelling, or restricted movement. This may require further surgery or intervention to stop the bleeding and restore function to the joint.

• • Intramuscular bleeding with compartment syndrome: A serious condition caused by a dangerous increase in pressure within a muscle compartment. This compartment contains muscles, blood vessels, and nerves, all enclosed by a tough membrane called the fascia. This increased pressure can restrict blood flow, depriving muscles and nerves of oxygen, which can lead to tissue damage.

• • Retroperitoneal bleeding: Bleeding in the space behind the abdominal cavity (the retroperitoneum). This may cause abdominal or back pain and visible bruising around the waist. It can be life-threatening, as the bleeding may not be immediately visible and can lead to shock if untreated.

If you experience any of these symptoms, seek medical care immediately. Prompt treatment is essential to prevent complications and ensure your safety.

2. Hemorrhagic Stroke

As an anticoagulant, Eliquis increases the risk of bleeding. In rare cases, this can lead to a hemorrhagic stroke, which occurs when a blood vessel in the brain ruptures and causes bleeding.

3. Severe Allergic Reactions

Some people may experience allergic reactions to Eliquis, which can include:

• • swelling of the face, lips, tongue, or throat
  • difficulty breathing or swallowing
  • severe skin rash or itching

In clinical trials, these reactions were reported in less than 1% of patients.

4. Spinal or Epidural Blood Clots

Blood clots around the spinal cord can lead to long-term or even permanent paralysis. Your chances of developing a spinal or epidural blood clot are higher if:

• • you have an epidural catheter placed in your back for medication delivery
  • you take NSAIDs or other blood-thinning medications, such as Eliquis
  • you have a history of complex or repeated spinal punctures
  • you have existing spinal issues or have previously had spinal surgery

If you are taking Eliquis and receive spinal anesthesia or a spinal puncture, your doctor should monitor you closely for signs of spinal or epidural blood clots or bleeding.

5. Anemia

Eliquis can increase the risk of anemia as a result of its bleeding side effects. Bleeding can lead to a decrease in red blood cells, contributing to anemia. Symptoms you might experience include:

• • dizziness
  • fatigue
  • accelerated heartbeat

Other signs can be leg cramps, cravings for ice, and paler skin than usual. Over time, you may also notice brittle nails and thinning hair.

Long-Term Side Effects of Eliquis

Taking Eliquis for extended periods may cause long-term risks, including:

1. Kidney Damage

While rare, some patients on Eliquis may experience kidney-related side effects, especially those with preexisting kidney conditions.

A study examined the impact of long-term anticoagulant use on kidney function. Direct oral anticoagulants (DOACs), including Eliquis, may be a safer choice than warfarin due to a lower risk of acute kidney injury (AKI). However, when it comes to long-term kidney function decline, both DOACs and warfarin appear to have similar effects on overall renal health.

In a specific case report, a patient with preexisting mild AKI experienced worsening kidney function shortly after starting apixaban. The patient developed oligoanuria (significantly reduced or stopped urine output), indicating severe kidney impairment.

If you have any kidney-related issues, be sure to inform your prescriber before starting Eliquis. They may need to adjust your dosage or monitor your kidney function more closely to reduce the risk of complications.

2. Bone Health

Research found that patients taking anticoagulants, including both warfarin and DOACs, had lower bone mineral density (BMD) and trabecular bone score (TBS) compared to those not using anticoagulants (the control group).

• • BMD shows the mineral content in bones, directly related to bone strength. Low BMD increases fracture risk and is a marker of osteoporosis.

• • TBS assesses the bone’s structural quality at a microscopic level. Lower TBS values mean poorer bone structure and a higher risk of fractures.

In the study, 50% of the DOAC group and 42% of the control group had low bone mass. TBS values also progressively decreased across the groups, with the control group having the highest TBS (1.328), followed by the DOAC group (1.264).

While Eliquis remains a preferred option among oral anticoagulants for many patients, it’s essential to be mindful of bone health. Taking preventive measures, such as engaging in weight-bearing exercises, ensuring adequate calcium and vitamin D intake, and regularly monitoring bone density, can help maintain bone strength and reduce fracture risk.

Side Effects of Eliquis in the Elderly

In the clinical studies:

• • ARISTOTLE and AVERROES: Over 69% of participants were aged 65 or older, and more than 31% were aged 75 or older.

• • ADVANCE-1, ADVANCE-2, and ADVANCE-3: Half of the participants were 65 or older, and 16% were 75 or older.

• • AMPLIFY and AMPLIFY-EXT: More than 32% of participants were 65 or older, and over 13% were 75 or older.

These studies showed no significant differences in safety or effectiveness across age groups. However, anemia may be more common in older adults, as the prevalence of anemia tends to increase with age.

Safety Tips While Taking Eliquis

Here are some essential safety tips to keep in mind while taking Eliquis:

• • Take Eliquis exactly as prescribed: Don’t skip doses or stop taking it without consulting your doctor, as this can increase your risk of blood clots. Set a reminder if needed to stay consistent.

• • Watch for signs of bleeding: Be alert for unusual bruising, prolonged bleeding, blood in your urine or stool, or persistent nosebleeds. If you notice these symptoms, contact your healthcare provider immediately.

• • Avoid activities with a high risk of injury: Since Eliquis increases your bleeding risk, try to avoid activities where you might get cuts, bruises, or injuries.

• • Use soft-bristle toothbrushes and electric razors: These can help reduce the risk of cuts or gum irritation, which could cause bleeding.

• • Limit alcohol intake: Alcohol can increase your bleeding risk due to its blood thinning effects.

• • Inform all healthcare providers that you’re on Eliquis: This includes your dentist and any specialists you see. They need to know about Eliquis if you’re planning surgery or dental procedures to take appropriate precautions.

• • Avoid NSAIDs and other blood thinners unless approved: Medications like ibuprofen, aspirin, or other blood-thinning drugs can increase your risk of bleeding when combined with Eliquis. Always consult your doctor before taking new medications.

• • Get regular check-ups: Keep up with appointments to monitor your blood health and kidney function.

If you have any concerns, reach out to your healthcare provider for guidance.

Wrap-up

Eliquis offers an effective way to prevent blood clots by inhibiting Factor Xa, reducing your risk of stroke, DVT, and PE. Unlike older anticoagulants, Eliquis doesn’t require frequent blood tests or strict dietary changes, making it a convenient choice. However, be mindful of possible side effects, including minor bleeding, which may need attention, and serious bleeding risks in critical areas.

If you’re older, take extra care, as side effects can be more pronounced. For safe use, take Eliquis exactly as prescribed, watch for signs of bleeding, avoid injury-prone activities, and inform your healthcare providers about your medication before any procedures.

Frequently Asked Questions