Side Effects of Eliquis (Apixaban)
The most important side effect of Eliquis (apixaban) is bleeding, which can occur in various forms including intracranial hemorrhage, gastrointestinal bleeding, and abnormal bruising. 1, 2
Common Side Effects
Bleeding-related side effects:
- Unexplained bruising
- Prolonged bleeding after minor cuts
- Blood in urine or stool
- Unusual headaches or dizziness 1
Skin reactions:
- Rash
- Severe allergic reactions (rare) 2
Risk Factors for Bleeding
Several factors can increase the risk of bleeding while taking apixaban:
Patient-specific factors:
- Advanced age (≥80 years)
- Low body weight (≤60 kg)
- Renal impairment
- History of bleeding
- Fall risk 1
Medication interactions:
- Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir)
- P-glycoprotein (P-gp) inhibitors
- SSRIs (e.g., sertraline)
- Antiplatelet medications 1
Special Populations at Higher Risk
Apixaban should be used with caution in:
- Renal impairment: Patients with severe renal impairment (CrCl <15 mL/min) should avoid apixaban 1
- Hepatic impairment: Patients with significant hepatic impairment (transaminases >2x upper limit of normal or total bilirubin >1.5x upper limit of normal) should avoid apixaban 1
- Elderly patients: Especially those ≥80 years 1
- Patients with antiphospholipid syndrome 2
Monitoring and Management
Patients taking apixaban should:
- Be monitored for signs of bleeding
- Inform healthcare providers about all medications they take
- Not stop taking apixaban without consulting their doctor
- Refill prescriptions before running out
- Notify their doctor immediately if they fall or injure themselves, especially head injuries 1, 2
Comparative Safety Profile
Compared to warfarin, apixaban has been associated with:
- Lower rate of intracranial hemorrhages
- Less adverse consequences following extracranial hemorrhage 3
- No need for routine anticoagulation monitoring 4, 5
Dosing Considerations
Incorrect dosing can lead to side effects:
- Underdosing may increase thromboembolic events
- Overdosing may significantly increase bleeding risk 1
A recent study (2023) found that in patients with atrial fibrillation and severe chronic kidney disease, the 5 mg dose was associated with a higher risk of bleeding compared to the 2.5 mg dose, with no difference in stroke prevention or mortality 6.
Important Warnings
- Do not stop taking apixaban without consulting your doctor - stopping can increase stroke risk in atrial fibrillation patients
- Report falls or injuries immediately to your healthcare provider
- Seek immediate medical attention for signs of severe allergic reaction (chest tightness, face/tongue swelling, trouble breathing, dizziness) 2
- Inform all healthcare providers including dentists about apixaban use before procedures 2