Eliquis Side Effects: What Are They?

Approximately 900,000 cases of potentially deadly blood clots, called deep vein thrombosis, are diagnosed in the United States each year, but if you’re like most Americans, you might not know what a blood clot is or be aware of the symptoms. Studies show that less than one in four American adults are familiar with blood clots and can identify their signs and symptoms, and this lack of knowledge is proving to be deadly; 274 people die in the United States from blood clots each day. Although most people don’t give any thought to blood clots, people who have had them know exactly how scary and serious they are. About 70 percent of blood clots are associated with known risk factors, such as surgery; these clots are considered “provoked.” The remaining 30 percent are considered “unprovoked,” meaning they occur without any identifiable risk factors present. Patients who have been diagnosed with a blood clot may be prescribed an anticoagulation medicine like Eliquis to help treat and prevent future clots. 

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Approximately 900,000 cases of potentially deadly blood clots, called deep vein thrombosis, are diagnosed in the United States each year, but if you’re like most Americans, you might not know what a blood clot is or be aware of the symptoms. Studies show that less than one in four American adults are familiar with blood clots and can identify their signs and symptoms, and this lack of knowledge is proving to be deadly; 274 people die in the United States from blood clots each day. Although most people don’t give any thought to blood clots, people who have had them know exactly how scary and serious they are. About 70 percent of blood clots are associated with known risk factors, such as surgery; these clots are considered “provoked.” The remaining 30 percent are considered “unprovoked,” meaning they occur without any identifiable risk factors present. Patients who have been diagnosed with a blood clot may be prescribed an anticoagulation medicine like Eliquis to help treat and prevent future clots. 

What Is Eliquis?

Eliquis belongs to a class of drugs called novel oral anticoagulants, which are commonly called blood thinners or antiplatelet medications. Blood thinners or factor xa inhibitors block the activity of certain clotting substances in the blood, which decreases the likelihood that clots will form. The U.S. Food and Drug Administration (FDA) first approved Eliquis for medical use in 2012; its original approval was for use to reduce the risk of stroke and blood clots in patients with nonvalvular atrial fibrillation. Eliquis received additional approvals in 2014 when the medication was approved for use to reduce the risk of blood clots following hip replacement or knee replacement surgery and for the treatment of deep vein thrombosis and pulmonary embolism. Eliquis was available only in its brand name form until December 2019, when the first generic forms of the medication, sold as apixaban, were approved by the FDA. 

What Conditions Are Treated With Eliquis?

Eliquis is FDA-approved for three uses:  prevention of blood clots and deep vein thrombosis in patients who have had hip or knee replacement surgery, treatment and prevention of deep vein thrombosis and pulmonary embolism, and reduction of the risk of stroke and blood clots in patients with nonvalvular atrial fibrillation.

Blood Clots and Deep Vein Thrombosis (DVT)

Normally, blood flows smoothly through the blood vessels from one part of the body to the next, delivering oxygen and nutrients along the way. If we get a cut or are injured and start to bleed, the body tells the blood to clot, which prevents us from losing too much blood and bleeding to death. Most of the time, the clotting properties of our blood are a good thing, but clots can sometimes form where they’re not supposed to, such as inside the blood vessels. When blood clots form in a deep vein, such as those in the legs, pelvis, and arms, they are called deep vein thrombosis and are potentially life-threatening. Deep vein thrombosis is a serious medical condition because the blood clot or part of a clot can break off and travel through the blood vessels towards the lungs or brain, causing a stroke or pulmonary embolism. Patients who have been diagnosed with deep vein thrombosis or blood clots are more likely to experience them again in the future, without about one out of every three deep vein thrombosis patients experiencing a recurrence within ten years. 

Pulmonary Embolism

Sometimes, deep vein thrombosis travels to the pulmonary arteries in the lungs, causing a pulmonary embolism. Pulmonary embolism is a blood clot in the pulmonary arteries that can reduce or cut off the blood supply to the lungs, making it a life-threatening condition that can sometimes cause sudden death. Symptoms of pulmonary embolism commonly include unexplained shortness of breath, chest pain, or bloody cough, but other symptoms include lightheadedness or dizziness, rapid or irregular heartbeat, excessive sweating, fever, leg pain or swelling, or clammy and discolored skin.

Nonvalvular Atrial Fibrillation

Nonvalvular atrial fibrillation is an irregular heart rhythm that cannot be attributed to deformities or irregularities in the heart valves, called valvular heart diseases. Patients diagnosed with nonvalvular atrial fibrillation are five times more likely to experience a stroke or systemic embolism because the heart shakes rather than pumping with a steady beat, which can cause blood to pool in the atrial chambers of the heart. This pooling can sometimes cause blood clots to form in the heart; these clots can break off and travel through the blood vessels to the brain, causing a stroke, which can be life-threatening. Eliquis helps prevent blood clots, thereby reducing the risk of stroke in patients with nonvalvular atrial fibrillation.

What Are the Side Effects of Eliquis?

Side effects associated with Eliquis are rare but can be potentially serious. The most common side effects associated with Eliquis include easy bruising and unusual bleeding, such as from the nose, mouth, vagina, or rectum, and bleeding from injection sites. However, some side effects can be serious. Rare but serious side effects associated with Eliquis include:

  • Blood in the eyes
  • Bloody or black, tarry stools
  • Confusion
  • Redness of the eye
  • Trouble breathing and/or wheezing
  • Unusual tiredness or muscle weakness
  • Blood in the urine
  • Bruising or purple areas on the skin
  • Nausea and vomiting
  • Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Severe stomach pain
  • Tightness in the chest
  • Vomiting of blood or material that looks like coffee grounds
  • Constipation
  • Decreased alertness
  • Dizziness
  • Coughing up blood
  • Difficulty swallowing
  • Fainting
  • Headache
  • Joint pain or swelling
  • Nosebleeds
  • Fast heartbeat
  • Hives, itching, or skin rash

Patients should seek medical help immediately and go to the emergency room if they experience any signs or symptoms of bleeding while taking Eliquis, including:

  • Coughing up or vomiting blood
  • Vomit that looks like coffee grounds
  • Unexpected bleeding or bleeding that lasts a long time, including unusual bleeding from the gums, frequent nosebleeds, or vaginal bleeding that is heavier than usual
  • Red or black stools
  • Unexpected pain, swelling, or joint pain
  • Bleeding that is severe or uncontrollable
  • Red, pink, or brown urine
  • Headaches

How Does Eliquis Work?

Eliquis lowers the chance of blood clot formation by lowering the clotting capacity of the blood. Specifically, Eliquis blocks the action of a blood-clotting protein called Factor Xa, which is critical in the clotting process. When Factor Xa is blocked, Eliquis causes the blood to clot more slowly, thereby reducing the likelihood of deep vein thrombosis and other blood clots and decreasing the risk of stroke. 

What Are the Benefits of Taking Eliquis?

The new generation of anticoagulants, including Eliquis, have many advantages over warfarin, which was previously the only blood-thinning option on the market. Warfarin is a life-saving medication, but taking it required restrictions that could make taking the medication highly inconvenient for patients. Compared to treatment with Warfarin, Eliquis has numerous benefits, including:

  • No monthly blood tests to ensure that the medication is working
  • Reduced risk of major bleeding problems because the medication wears off more quickly than warfarin
  • Fewer drug interactions.
  • No dietary restrictions while taking the medication

What Risks Are Associated With Taking Eliquis?

Although Eliquis has many benefits, taking the medication is not without risks. Risks associated with Eliquis include:

  • Increased ease and likelihood of bruising
  • Bleeding may take longer to stop 
  • A higher risk of bleeding when taken with certain drugs, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen, warfarin, heparin, selective serotonin reuptake inhibitors (SSRIs), or serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as other medications that prevent or treat blood clots like coumadin, thrombin, clopidogrel, or enoxaparin. 
  • Serious blood clots in the spine, potentially causing paralysis, can occur if a patient receives a spinal puncture or spinal anesthesia while taking the medication
  • Stopping Eliquis suddenly increases your risk of a blood clot or stroke
  • Increased risk of severe or fatal bleeding, including internal bleeding
  • The medication cannot be taken while having surgery, an invasive procedure, or some dental work.

What Dose of Eliquis Should I Take?

Eliquis is a prescription drug that is taken twice per day, at twelve-hour intervals, with or without food. Many doctors recommend taking it with applesauce or apple juice to make it easier. The medication is offered at 2.5 mg and 5 mg strengths, and dosing instructions based on the medication guide will vary based on the condition being treated, the age of the patient, and other medical factors. Patients who are taking Eliquis to prevent blood clots or deep vein thrombosis are likely to take one 2.5 mg tablet twice per day, while patients taking Eliquis to break up existing blood clots are likely to take one 5 mg tablet twice per day. Patients are only prescribed Eliquis when they truly need the medication, so it’s important that the medication be taken as prescribed and avoid missed doses and keep up with their refills, as not doing so can increase the risk of having a stroke or forming a blood clot.

Can Women Who Are Pregnant or Breastfeeding Take Eliquis?

No data from clinical trials exist that demonstrates a link between taking Eliquis during pregnancy and fetal injury or morbidity. However, taking Eliquis during pregnancy is considered risky due to the high-risk of hemorrhage during pregnancy and delivery. Therefore, Eliquis should only be taken by pregnant women if the potential benefit to the mother clearly outweighs the risks. Women must either stop breastfeeding or stop taking Eliquis. Women who are breastfeeding or planning to breastfeed should seek medical advice from their healthcare provider, as Eliquis passes through breast milk and is not considered safe for infants. Breastfeeding mothers should not take Eliquis and breastfeed. 

Who Should Not Take Eliquis?

Eliquis should not be taken by patients with any of the following conditions:

  • Have artificial heart valves
  • Have certain types of abnormal bleeding
  • Have antiphospholipid syndrome (APS), particularly with positive triple antibody testing, with a history of blood clots
  • Have had a serious allergic reaction to Eliquis.
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