From the Guidelines
Bruising that occurs on Apixaban is commonly referred to as Apixaban-induced ecchymosis, a side effect resulting from the medication's anticoagulant properties that inhibit Factor Xa in the blood clotting cascade. This condition is characterized by an increased tendency to bruise easily, with bruises potentially being larger or taking longer to heal than usual. The mechanism behind this is the impairment of the normal clotting process, making even minor trauma to blood vessels lead to more bleeding under the skin 1. Key points to consider include:
- Apixaban's efficacy in reducing stroke and systemic embolism risk in patients with nonvalvular atrial fibrillation, as demonstrated in trials such as ARISTOTLE and AVERROES 1.
- The importance of patient awareness regarding the expected side effect of bruising and the need to report unusual or severe bruising to healthcare providers.
- Precautions to be taken before procedures, including informing healthcare providers about Apixaban use, to prevent excessive bleeding.
- The recommendation for patients to avoid high-risk activities while on Apixaban to minimize bruising and bleeding complications. Given the most recent and highest quality evidence, patients on Apixaban should be managed with caution, balancing the benefits of stroke prevention with the risks of bleeding and bruising, and healthcare providers should closely monitor patients for any signs of excessive bleeding or bruising 1.
From the FDA Drug Label
While taking apixaban tablets: you may bruise more easily
The bruising that occurs on Apixaban is not given a specific name in the provided drug labels, it is simply referred to as bruising. 2 2
From the Research
Bruising on Apixaban
- Bruising that occurs on Apixaban is a result of the drug's anticoagulant effect, which can increase the risk of bleeding and bruising 3, 4.
- The studies do not provide a specific name for bruising that occurs on Apixaban, but it is referred to as a bleeding event or adverse event associated with anticoagulant therapy 5, 6.
- The risk of bruising and bleeding on Apixaban can be increased in certain situations, such as renal impairment, advanced age, and concomitant use of other medications that increase the risk of bleeding 3, 7.
Risk Factors for Bruising on Apixaban
- Renal impairment: Apixaban is eliminated by the kidneys, and renal impairment can increase the risk of bleeding and bruising 5, 6.
- Advanced age: Older adults may be at increased risk of bleeding and bruising on Apixaban due to age-related changes in renal function and other factors 3.
- Concomitant use of other medications: The use of other medications that increase the risk of bleeding, such as antiplatelet agents and nonsteroidal anti-inflammatory drugs, can increase the risk of bruising and bleeding on Apixaban 3, 6.
Management of Bruising on Apixaban
- Monitoring for signs of bleeding: Clinicians should monitor patients on Apixaban for signs of bleeding, including bruising, and adjust the dose or discontinue the medication as needed 5, 7.
- Dose adjustment: The dose of Apixaban may need to be adjusted in patients with renal impairment or other risk factors for bleeding 5, 6.
- Concomitant use of other medications: Clinicians should be cautious when using Apixaban with other medications that increase the risk of bleeding, and monitor patients closely for signs of bleeding 3, 6.