What Is Eliquis Used For?

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If you’ve never had a blood clot, you probably have never given them a second thought, but if you have, you know exactly how scary they can be. Studies show that fewer than one in four people have any knowledge about blood clots or how to detect them, and lack of public awareness about blood clots is part of what makes them so deadly; approximately 274 people die in the United States each day from blood clots. There are approximately 900,000 cases of potentially deadly blood clots, called deep vein thrombosis, diagnosed each year in the United States. About 70 percent of these clots are considered “provoked,” meaning they are associated with known risk factors, while the remaining 30 percent are considered “unprovoked,” meaning they occur without any identifiable risk factors present. Eliquis is one of several new blood thinners on the market that can help prevent or treat blood clots.

What Is Eliquis?

Eliquis, also sold under the generic name apixaban, belongs to a class of drugs called novel oral anticoagulants, blood thinners, or antiplatelet medications. Medications like the brand name Eliquis work as a factor Xa inhibitor blocking the activity of certain clotting substances in the blood, helping to reduce the chances of blood clots forming. Eliquis was first approved by the U.S. Food and Drug Administration (FDA) in 2012 for use in reducing the risk of stroke and blood clots in patients with nonvalvular atrial fibrillation, and it received additional FDA approvals in 2014 when it was approved 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 and medications like it are only available with a prescription. In December 2019, the first generic forms of the medication, sold as apixaban, were approved by the FDA, helping to lower the cost of the medication.  

What Is Eliquis Used For?

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

Blood Clots and Deep Vein Thrombosis (DVT)

Blood is designed to flow smoothly from one part of the body to the other, delivering oxygen and nutrients to the organs and tissues. When we are injured, the body tells the blood to clot, or congeal, in order to prevent us from losing too much blood and bleeding to death. Generally speaking, the ability of our blood to clot is a good thing, but sometimes blood clots when it is not supposed to, such as inside the blood vessels. Blood clots that form in a deep vein, usually in the legs, pelvis, or arms, are deep vein thrombosis. This potentially serious condition can be life-threatening 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. Experiencing one deep vein thrombosis or blood clot puts patients at a high-risk of experiencing additional clotting issues; about one out of every three people with deep vein thrombosis will have a recurrence within ten years. 

Pulmonary Embolism

When a blood clot travels to the pulmonary arteries in the lungs, usually from deep vein thrombosis, it is referred to as a pulmonary embolism. Pulmonary embolism 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 shortness of breath, a bloody cough, or chest pain, but other symptoms include rapid or irregular heartbeat, lightheadedness or dizziness, excessive sweating, fever, leg pain or swelling, or clammy and discolored skin.

Nonvalvular Atrial Fibrillation

Nonvalvular atrial fibrillation is an irregular heartbeat that cannot be attributed to valvular heart diseases, which cause irregularities in the heart valves. Having nonvalvular atrial fibrillation increases a patient’s chances of stroke by five times because the heart does not pump blood with a steady beat, which can cause blood to pool in the atrial chambers of the heart, sometimes leading to blood clots forming in the heart. If a blood clot or part of a blood clot breaks off and travels through the blood vessels to the brain, a stroke occurs, which can be life-threatening. Eliquis helps reduce the likelihood of blood clots, thereby reducing the risk of stroke in patients with nonvalvular atrial fibrillation.

How Do Anticoagulants Like Eliquis Work?

Novel oral anticoagulants, like Eliquis, are often called “blood thinners” because they lower the chance of blood clot formation by lowering the clotting capacity of the blood. Eliquis works specifically on a blood-clotting protein called Factor Xa, which is critical in the clotting process.  By blocking Factor Xa, Eliquis causes the blood to clot more slowly, helping to reduce the incidence of deep vein thrombosis and other blood clots and decrease the likelihood of stroke. 

What Are the Benefits of Eliquis?

Blood thinners like Eliquis belong to a new generation of anticoagulants; previously, the only blood thinner available on the market was warfarin (Coumadin). While warfarin is a life-saving medication, it also came with many risks and restrictions that could make taking the medication highly inconvenient for patients. Compared to treatment with Warfarin, Eliquis has numerous benefits, including:

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

What Risks Are Associated With Eliquis?

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

  • A higher risk of bleeding when combined with medications like 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 clopidogrel, thrombin, or enoxaparin
  • Increased ease and likelihood of bruising
  • Bleeding may take longer to stop 
  • 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
  • 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.

What Dose of Eliquis Should I Take?

Eliquis is offered in 2.5 mg tablets and 5 mg tablets and is taken twice per day, at twelve-hour intervals, with or without food. Many doctors recommend mixing the medication into applesauce or apple juice. Dosing instructions for Eliquis depend on the condition being treated, your age, and other medical conditions. A typical treatment-level dose of Eliquis, meaning the medication is being used to break up existing blood clots, is typically taking one 5 mg tablet twice per day. Prevention of blood clots or deep vein thrombosis is generally provided by taking one 2.5 mg tablet twice per day. As with many prescription drugs, it is critical that patients who are prescribed Eliquis follow the medication guide and take their medication as prescribed and avoid missed doses and keep up with their refills, as not doing so can increase your risk of having a stroke, systemic embolism, or forming a blood clot.

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:

  • 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
  • Constipation
  • Decreased alertness
  • Dizziness
  • Blood in the eyes
  • Bloody or black, tarry stools
  • Confusion
  • Coughing up blood
  • Difficulty swallowing
  • Fainting
  • Headache
  • Joint pain or swelling
  • Nosebleeds
  • Fast heartbeat
  • Hives, itching, or skin rash
  • 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

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:

  • 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
  • Coughing up or vomiting blood
  • Vomit that looks like coffee grounds
  • Unexpected pain, swelling, or joint pain
  • Bleeding that is severe or uncontrollable
  • Red, pink, or brown urine
  • Headaches
  • Feeling dizzy or weak

Can Pregnant Women or Breastfeeding Women Take Eliquis?

Conclusive studies and clinical trials on the effects of taking Eliquis during pregnancy have not been conducted. Because Eliquis can cause the blood to clot more slowly and can increase the risk of bleeding episodes, Eliquis should only be taken during pregnancy if the potential benefit to the mother clearly outweighs the risks due to the increased risk of hemorrhage during pregnancy and delivery. 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. Women must either stop breastfeeding or stop taking Eliquis.

Who Should Not Take Eliquis?

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

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