Starting a new medication can often be a nerve-wracking experience. Not only can the underlying condition that it seeks to treat be a source of anxiety, but the prospects of side effects from the medication can be concerning, especially when those side effects can be severe. Fortunately, many modern medications have relatively few side effects, and doctors only prescribe medications where the positive impacts will outweigh the potential downsides. Still, patients can benefit from doing their own due diligence with regards to reducing the possibility of side effects wherever possible.

Eliquis is a commonly prescribed blood thinner that can carry a risk of severe side effects. This article will outline the benefits of Eliquis for certain patients, and will detail some steps that patients can take to reduce the likelihood of experiencing negative side effects while taking Eliquis.

What is it, and what is it used for?

Eliquis is the brand name for apixaban, a drug that falls under the category of blood thinners. Like other blood thinning medications, Eliquis is useful in decreasing the likelihood of a stroke in individuals who are prone to strokes for various reasons. Broadly, it accomplishes this goal by decreasing the blood’s natural tendency to thicken and form sticky solid globs that do not flow like liquid blood.

Typical Eliquis patients include individuals who suffer from atrial fibrillation, a form of irregular heart rhythm (arrythmia) that can cause blood to circulate poorly from the heart. This increases the chances of blood forming small clots that can block the bloodstream upon leaving the heart. Taking Eliquis decreases the likelihood of this occurring by preventing the formation of such clots in the first place.

A brief history of Eliquis

Eliquis is not the first blood thinning medication used to prevent strokes among demographics of people who are more prone to them. In fact, it was only approved by the FDA in 2012, before which, drugs like warfarin were commonly used to treat the same issues. Eliquis was approved following the results of a large 2011 study which compared the prevalence of strokes among populations using Eliquis to those using warfarin. The study showed that the population taking Eliquis experienced a significantly lower rate of strokes, as well as significantly fewer episodes of major bleeding. Ever since those promising results, Eliquis has been considered among the first-line choices of medication for the preventive treatment of strokes in patients with non-heart valve related atrial fibrillation.

How does it work?

To understand how Eliquis makes strokes less likely, it is important to first understand what causes blood clots to form. Blood is a very complex mixture of chemicals, hormones, blood cells, and nutrients, that serves many important functions throughout the body. Because it is so important, the body has developed systems to prevent the loss of too much blood, which can be fatal. The body’s primary defense against blood loss is to quickly clog up any openings in the circulatory system, such as cuts, scrapes, or puncture wounds. Coagulants are the class of molecules in the bloodstream that accomplish this exact task by causing blood to clump up when it is no longer being circulated effectively, as in the case of a bleed.

Factor Xa is one particular coagulant that is produced in and secreted by the liver. Eliquis works by binding to Factor Xa, rendering it ineffective at performing its role of coagulating in blood. This makes blood much less effective at clotting, hence reducing the risk of inappropriate blood clots that can form and block blood supply to critical regions of the body, like the brain.

What are some common side effects?

Many common side effects are the result of excessive bleeding. These include nosebleeds, bleeding gums, and anemia. Other side effects can include fatigue, headaches, joint pain and muscle weakness, and nausea.

While these side effects are more common, they tend not to be as severe as the less common side effects described below. Please note that this list is not exhaustive, and every person reacts uniquely to medications. If you suspect you are experiencing an abnormal effect, you should express your concern to your doctor.

What are the less common but more severe side effects?

Certain side effects pose a far greater risk of real injury or even death. Perhaps the greatest risk is that of a major bleed, which is any scenario where a dangerous amount of blood is lost through an opening in the circulatory system.  The blood’s inability to clot can turn a fairly benign cut into a major bleed. Fortunately, major bleeds are rare, occurring in as few as only 2.13% patients taking Eliquis.

One particular kind of bleeding event can be especially dangerous, and can result in paralysis in severe cases. Certain spinal surgeries involve puncturing the spinal cord to collect fluid, repair damage, or inject medication (as with epidurals). These procedures can pose a greater risk to patients on Eliquis, because the puncture wound may blead excessively and lead to blood pooling in the spine. In some cases, this can damage the spinal cord and lead to paralysis. Always inform doctors that you are taking Eliquis before any surgical procedures, and inform them of any recent procedures before beginning a course of Eliquis.

What are some ways to reduce the chances of side effects?

Don’t discontinue without talking to your doctor

Once you begin taking Eliquis, it is very important that you do not stop taking it abruptly. Doing so can cause a rebound effect in your blood’s clotting ability that can drastically increase the risk of a stroke following a missed dose.

If you wish to discontinue Eliquis, it is very important that you only do so under the guidance and supervision of a doctor, who can closely monitor you for issues while you discontinue the medication.

Dietary considerations

It is not uncommon for medications to interact with certain foods that we might otherwise consume without issue. Eliquis is not as sensitive to dietary interactions as other blood thinners, but caution should still be exercised with respect to certain foods.

Many blood thinners react negatively to vitamin K consumption. Thankfully, Eliquis is not included among this category, making it easier for patients to choose their diet. However, like many medications, Eliquis may interact negatively with grapefruit and grapefruit juice, so it may be advisable to avoid these in your diet while you take Eliquis.

Be cautious about taking antidepressants

Some patients report experiencing symptoms of depression after initiating treatment with Eliquis. Studies have revealed no conclusive link between Eliquis and depression, but if you do notice any changes in your mood after taking Eliquis, you should bring these concerns to your doctor.

If you were already being treated for depression prior to commencing Eliquis, some of the antidepressants that you may be taking might interact negatively with Eliquis. If your doctor has decided to discontinue your antidepressant treatment to avoid negative interactions, you may wish to speak to them about an alternative antidepressant if your depressive symptoms return or worsen.

Avoid taking it with other medications that increase chances of bleeding

Many of the potential side effects of Eliquis relate to excessive bleeding due to the anticoagulant properties of Eliquis. Taking other blood-thinning medications while taking Eliquis can make these problems even worse, since the effects of both medications will compound one another.

Examples of such medications include other anticoagulant agents, certain classes of antidepressants (including SSRIs and SNRIs), ibuprofen and other NSAID painkillers, and aspirin. Before consuming any of these medications while taking Eliquis, consult with your doctor and pharmacist to ensure you will not risk more severe side effects by combining the drugs.

Be careful doing activities likely to cause bleeding

Though blood clotting may pose a risk of stroke for certain individuals, it also serves the very important function of preventing you from losing dangerous levels of blood when you cut, scrape, or bruise yourself. Taking an anticoagulant like Eliquis can make activities that would otherwise be relatively safe very dangerous. Any activity that is likely to increase your chances of bleeding – such as contact sports, cycling, or rollerblading – should be approached with caution. Ensure you have a plan in place to respond to bleeds if they do occur, to prevent a major bleed from occurring.

People should also be aware of their menstrual flow, since Eliquis can lead to a very heavy flow that can rise to the level of posing a health risk if too much blood is lost.


For populations at risk of stroke, harm reduction is the name of the game. Eliquis and other anticoagulants can go to great lengths to minimize the chance of suffering a stroke, which can often be fatal or lead to reductions in quality of life. The unfortunate truth is that these medications don’t come without risk. Ultimately, patients who are prescribed Eliquis are likely to sustain greater benefits from the medication than any detrimental effects. But being aware of how these medications function and the ways in which one might suffer the resulting side effects can help patients minimize the potential for harm.