If you’re at risk for blood clots, your doctor may suggest that you try a medication called apixaban (brand name Eliquis), which may help prevent clots that can cause serious health issues like stroke, pulmonary embolism and deep vein thrombosis.
Paul Thompson, a pharmacist with Banner Pharmacy Services, explained more about this medication.
What is apixaban (Eliquis)?
Apixaban belongs to a class of drugs known as anticoagulants (blood thinners). Apixaban works differently than most traditional blood thinners. It reduces your blood’s ability to form dangerous clots by blocking a protein called Factor Xa.
It’s generally prescribed for people with a risk of blood clots from:
- Atrial fibrillation (AFib): A condition where the heart’s upper chambers (atria) beat irregularly, increasing the risk of clots forming and traveling to the brain, where they could cause a stroke.
- Deep vein thrombosis (DVT): This occurs when a blood clot forms in a deep vein, usually in the legs. It can cause pain and swelling and if a part of the clot breaks off, it can travel to the lungs causing a pulmonary embolism.
- Pulmonary embolism (PE): A pulmonary embolism is a life-threatening condition where a blood clot blocks one or more lung arteries.
- Post-surgical prevention: There is an increased risk of blood clots after hip or knee replacement surgery.
Apixaban is mainly used to prevent new blood clots from forming rather than to dissolve existing clots. But it may be prescribed to treat certain types of blood clots, such as pulmonary embolism or deep vein thrombosis, in some cases.
Benefits of apixaban
One of the main reasons to take apixaban is to lower your risk of blood clots and stroke or other serious complications these clots can cause.
Apixaban has a lower risk of causing major bleeding compared to some other blood thinners, such as warfarin. Less bleeding risk means it may be safer than many other options.
You can take apixaban once or twice a day, so it’s easy to add to your daily routine. Because it doesn’t require regular blood monitoring, it may be more convenient than other blood thinners.
“Eliquis can be expensive, but patient assistance programs and discounts are available. Discuss these options with your health care provider or pharmacist if cost is a concern,” Dr. Thompson said.
How to take apixaban
Your health care provider will prescribe a dosage of apixaban for you based on your health condition, age, weight, kidney function and other medications you may be taking. Be sure to follow your provider’s instructions and take the correct dose at the recommended times.
“If you need to switch from Eliquis to another anticoagulant or vice versa, it requires careful planning and coordination with your health care provider to ensure continuous protection against blood clots,” Dr. Thompson said.
You may be able to take apixaban with or without food. “Take Eliquis exactly as prescribed. Do not skip doses or stop taking it without consulting your health care provider,” Dr. Thompson said. Stopping apixaban suddenly can increase the risk of blood clots. Follow your provider’s instructions about when and how to stop taking apixaban, especially if you’re switching to a different medication or preparing for surgery.
If you forget to take a dose, take it as soon as you remember. If it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a missed dose.
If you take apixaban and you’re traveling, make sure you have enough medication to last for your trip. If you’re traveling across time zones, talk to your provider about adjusting your dosing schedule.
“If you are pregnant, planning to become pregnant or breastfeeding, discuss the risks and benefits with your health care provider,” Dr. Thompson said.
Consult your provider if you have any questions or concerns about how to take apixaban.
Possible interactions with other medications or supplements
“Always inform your health care provider about all other medications, vitamins and supplements you are taking,” Dr. Thompson said. Interactions with apixaban can make it less effective or increase the risk of side effects.
Some medications that may interact with apixaban include:
- Other blood thinners (anticoagulants) or antiplatelet drugs
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Aleve)
- Certain antibiotics and antifungal medications
- St. John’s Wort and other herbal supplements
Your provider can review your medication list to spot any possible interactions and adjust your treatment plan if needed.
Risks and side effects of apixaban
If you’re taking apixaban, your health care provider will want to schedule regular checkups to evaluate your health, watch for side effects and check for kidney function problems.
“Unlike some other anticoagulants, Eliquis doesn’t require regular blood monitoring. But it’s still important to have regular checkups,” Dr. Thompson said.
Your provider will make sure you are on the right dose of apixaban and may recommend a lower dose if you have kidney problems.
Most people who take apixaban tolerate it well. But it may cause side effects such as:
- Bruising: Because your blood doesn’t clot as well, you may notice bruising even from minor injuries.
- Nosebleeds: Nosebleeds can occur more often when you are taking apixaban.
- Digestive problems: You may notice stomach pain, nausea or diarrhea.
These side effects are often mild and clear up on their own. Contact your health care provider immediately or go to the emergency room if you notice more serious side effects such as:
- Severe or long-lasting bleeding
- Unexpected bruising or bleeding from the gums
- Blood in the urine or stool
- Long-lasting or severe stomach pain
- Severe headache, dizziness or weakness
- Difficulty breathing or chest pain
These symptoms could indicate a serious complication or reaction to apixaban. Your provider can review your symptoms and recommend a course of action.
A medication that may reverse the effects of apixaban, andexanet alfa (Andexxa), was approved relatively recently. “It might not be available in all medical facilities, which can be crucial in emergency bleeding situations,” Dr. Thompson said.
Safety precautions with apixaban
If you take apixaban or another blood thinner, it’s important to wear medical alert identification such as a bracelet or necklace. That way, health care professionals can provide the treatment you need and take steps to avoid bleeding, even if you can’t communicate.
“Make sure all your health care providers, including your dentist, know that you are taking Eliquis, especially before any surgical or dental procedures,” Dr. Thompson said. You may need to adjust your treatment plan to reduce your risk of bleeding during or after the procedure. Don’t stop or change your medication without talking to your health care provider.
Your provider may also prescribe other medications to lower your risk of blood clots when you’re not very mobile, such as after surgery.
Talk to your health care team if you have any questions or concerns about managing your medication before medical procedures.
Lifestyle considerations with apixaban
Choosing a balanced diet that includes a range of nutritious foods is important. “While Eliquis has fewer dietary restrictions compared to warfarin, maintaining a healthy lifestyle and diet is important for overall health,” Dr. Thompson said.
Some foods can interact with apixaban or change how well it works:
- Foods that are high in vitamin K, including leafy greens like spinach, kale and broccoli, may interfere with apixaban. You don’t need to completely avoid these foods unless your provider recommends it, but it’s a good idea to keep your intake consistent and avoid sudden changes.
- Grapefruit and grapefruit juice can increase the risk of side effects from apixaban, so it’s best to avoid them.
- It’s generally considered safe to drink moderate amounts of alcohol if you’re taking apixaban. But drinking too much alcohol can increase the risk of bleeding and other side effects.
You’ll want to get regular exercise and maintain a healthy weight, especially if you’re at risk for blood clots or stroke. Talk to your provider before starting a new exercise program or making significant lifestyle changes. “Be cautious with activities that increase your risk of bleeding or injury,” Dr. Thompson said.
The bottom line
If you need medication to reduce blood clots, your health care provider may recommend apixaban (Eliquis). It may be a better option than other anticoagulants and blood thinners. Be sure to talk to your provider or an expert at Banner Health about the benefits and risks of any medication you’re taking.
Other useful articles
- 4 Surprising Ways AFib Could Affect Your Body
- What Can Go Wrong When You Mix Alcohol and Medications
- 5 Things to Know About Taking Blood Thinners
The content in this article is for informational use only. Always discuss any medication with your health care provider or pharmacist before taking it. Also refer to the medication package insert supplied by the pharmaceutical manufacturer with your prescription.
