Key Points

• Eliquis is used to treat and prevent blood clots in people with conditions such as atrial fibrillation or who are at risk of developing deep vein thrombosis or pulmonary embolism.
• The most common side effect is bleeding, which can be slight, such as nosebleeds or bleeding gums; or severe, such as blood in the urine or stool. Overall, Eliquis is less likely to cause bleeding than warfarin.
• If you are scheduled to have surgery or a medical procedure that has a risk of bleeding, you may need to stop Eliquis temporarily. But you should not stop taking Eliquis without talking to your healthcare provider first, because stopping it suddenly can increase your risk for blood clots.
• Eliquis is called a direct oral anticoagulant (DOAC) because it works directly on a substance called factor Xa, blocking it, which makes blood less likely to clot. Older anticoagulants, such as warfarin, work more generally, depleting vitamin K reserves which are needed to form clotting factors.

Introduction

Eliquis is an anticoagulant that is preferred over older anticoagulants, such as warfarin, because it doesn’t require regular blood tests, has fewer drug and food interactions, and it is less likely to cause bleeding. Although Eliquis is generally well tolerated, like any medication, it does have some side effects. We look in detail at six of the most common side effects of Eliquis:

• Slight bleeding
• Severe bleeding
• Feeling sick (nausea)
• Spinal blood clots
• Increased liver enzymes and liver injury
• Blood clots when stopping Eliquis.

Slight bleeding

Although Eliquis has a lower risk of bleeding than warfarin, minor bleeding, such as nosebleeds, bleeding gums, menstrual periods that are heavier than normal, or easy bruising, are common side effects. Generally, you may only notice this if you cut yourself and it takes a while longer for you to stop bleeding, or when you brush your teeth and your gums bleed. Always be prepared – carry a box of Band-Aids with you just in case you cut yourself when you are out and let any vaccinators know that you take Eliquis just in case you bleed from the vaccination site. Use a soft toothbrush when brushing your teeth and remove any trip hazards or clutter from your home to reduce your risk of falls or collisions with furniture.

If you do bleed, and it doesn’t stop on its own, or you are concerned about how heavy your menstrual periods are, ring your healthcare provider, or go to the emergency department if the bleeding is severe.

Severe bleeding

Severe bleeding, such as bleeding internally from the digestive tract, brain, kidneys, or from an open wound, is uncommon with Eliquis, affecting 3% or fewer people. But it can happen, and you should be alert for signs that may include:

• Coughing or vomiting up blood or blood clots (these may look like dried coffee grounds)
• Pink or brown urine
• Red or black tar-like stools
• Severe or unstoppable bleeding
• Signs of a stroke – such as sudden dizziness, headache, or loss of vision; difficulty with speech or slurring of your words; or one side of your face drooping.

Call 911 if you experience any of these. If the severe bleeding is caused by Eliquis, an antidote called andexanet alfa is available, so you must seek help quickly.

Tell all your healthcare providers that you are taking Eliquis. Eliquis may need to be temporarily stopped at least 48 hours before surgery which has a moderate-to-high risk of significant bleeding or 24 hours before surgery with a low risk of bleeding. Eliquis should be restarted once the risk of bleeding following surgery has returned to normal.

Feeling sick (nausea)

Nausea (feeling sick) has been reported by a small number of people (around 3%) taking Eliquis. Sometimes taking Eliquis with food or a snack can help relieve nausea symptoms but if nausea persists, talk to your healthcare provider about it, as it can be a sign of internal bleeding. Although ginger can help with nausea, you should not take too much of this natural remedy because it can also thin the blood and may increase your risk of bleeding.

Spinal blood clots

People taking Eliquis who must undergo a spinal (lumbar) tap, epidural, or other spinal procedure have an increased risk of developing a blood clot in their spinal cord (called a spinal or epidural hematoma), that could cause long-term or permanent paralysis. The risk is greater in those who take other medications that also affect blood clotting (such as aspirin, NSAIDs [diclofenac, ibuprofen, or naproxen], or SSRIs), or with a history of traumatic or repeated spinal procedures, spinal deformity, or spinal surgery. Sometimes, a spinal hematoma can occur spontaneously in somebody taking Eliquis who has no risk factors.

Symptoms of a spinal hematoma include numbness, tingling, or weakness in your lower back. Spinal hematomas can cause permanent damage to the brain, long-term disability, and can be fatal in some people, so if you experience any of these symptoms, especially after a spinal procedure, contact your healthcare provider urgently.

If you are scheduled for a spinal tap or other procedure, your healthcare provider will usually stop Eliquis a day or two before surgery, and then restart it again a day or two later.

Increased liver enzymes and liver injury

Increases in serum transaminases, aspartate aminotransferase, gamma-glutamyl transferase, and other liver enzymes are uncommon, affecting 1% or less of all people who take Eliquis and post-marketing surveillance has revealed several cases of mild but clinically apparent liver injury, and elevations in serum aminotransferase of greater than 3 times the upper limit of normal have been reported. Liver toxicity tended to occur within days of starting Eliquis and resolved rapidly once Eliquis was discontinued. The rate of liver injury with Eliquis appears similar to that of rivaroxaban.

Signs of liver injury/toxicity include:

• Yellowish tone to the skin and eyes
• Abdominal pain and swelling
• Dark urine
• Edema in the legs and ankles
• Itchy skin
• Nausea or vomiting
• Tiredness.

See your doctor immediately if you develop any signs or symptoms suggestive of liver toxicity.

Blood clots when stopping Eliquis

Eliquis is very good at preventing and treating blood clots while you are taking it, but it is possible to develop blood clots if you stop taking Eliquis suddenly or stop taking it before an existing blood clot has properly dissolved. Blood clots anywhere in the body are dangerous because they can dislodge or break apart and end up blocking small blood vessels around the heart, lungs, or brain, leading to a heart attack, pulmonary embolism, or stroke.

Eliquis is usually taken for at least 6 months, but some people may take it for only a few months, and others for the rest of their life. Your healthcare provider will tell you how long you need to take Eliquis, and when (if ever) to stop it. Stick to their plan or talk to them before stopping it if you find you are not tolerating Eliquis.

Signs and symptoms of a blood clot include:

• Swelling, pain, or redness in a limb
• Coughing up blood
• Chest pain
• Difficulty breathing or feeling very short of breath
• A fast or irregular heartbeat
• Severe headaches

Seek urgent medical attention if you develop any of these symptoms.

For more information on Eliquis see Eliquis: 7 things you should know