From the Guidelines
For an elderly person on Eliquis (apixaban) who has developed a bad bruise, it is crucial to hold the medication temporarily and seek immediate medical evaluation to assess the severity of the bruising and bleeding risk. The decision to hold the medication should be made by the patient's healthcare provider, taking into account the severity of the bruising, bleeding risk, and the reason for anticoagulation 1. Important laboratory tests include:
- A complete blood count (CBC) to assess hemoglobin levels and platelet count
- Coagulation studies including PT/INR and aPTT, although these may not be highly sensitive for apixaban 1
- Renal function tests (BUN, creatinine) since Eliquis is partially eliminated by the kidneys
- Consideration of viscoelastic coagulation tests, such as thromboelastograph (TEG) or rotational thromboelastogram (ROTEM), which can provide rapid detection of coagulation disorders, although their utility in trauma patients is limited by the need for urgent decision-making 1 The patient's healthcare provider needs to balance bleeding risks against thrombotic risks based on the individual's specific situation, considering the half-life of Eliquis (approximately 12 hours) and the suggested duration for withholding DOAC based on bleed risk 1. Temporary discontinuation might be appropriate if there is significant bleeding or high risk of bleeding, but stopping Eliquis without medical guidance could increase stroke risk in patients taking it for atrial fibrillation or increase clot risk in those taking it for DVT/PE. The patient should seek prompt medical evaluation rather than making medication changes independently.
From the FDA Drug Label
If anticoagulation with apixaban is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant [see Dosage and Administration (2.4), Warnings and Precautions (5.1), and Clinical Studies (14. 1)]. Apixaban tablets should be discontinued at least 48 hours prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding [see Warnings and Precautions (5. 2)] .
The patient should hold the medication if the bruise is considered a pathological bleeding. To assess the situation, the following labs should be drawn:
- INR (International Normalized Ratio): to assess the patient's coagulation status
- Complete Blood Count (CBC): to evaluate for any signs of bleeding or anemia
- Creatinine: to assess renal function, as apixaban is renally cleared
- Liver function tests: to evaluate for any signs of liver injury or dysfunction
From the Research
Laboratory Tests for Elderly Person on Eliquis with a Bad Bruise
To assess the anticoagulant activity of Eliquis (apixaban) in an elderly person with a bad bruise, the following laboratory tests may be considered:
- Prothrombin time (PT) 3, 4, 5
- Activated partial thromboplastin time (APTT) 3, 4, 5
- Anti-factor Xa activity (AXA) 6
- Thrombin generation parameters 7
- Fibrinogen and antithrombin activity 5
Holding Eliquis Medication
The decision to hold Eliquis medication in an elderly person with a bad bruise should be based on the clinical judgment of the healthcare provider, taking into account the patient's individual risk factors and the severity of the bruise.
- Studies have shown that apixaban can affect thrombin generation parameters, including lag-time, endogenous thrombin potential, and thrombin-peak 7.
- However, the effect of apixaban on PT and APTT is minimal, and these tests may not be reliable for assessing the anticoagulant activity of apixaban 4, 5.
- Anti-factor Xa activity (AXA) may be a more sensitive test for assessing the anticoagulant activity of apixaban 6.
Considerations for Laboratory Testing
When interpreting laboratory results, it is essential to consider the following: