What patient education is required for someone being put on Eliquis (apixaban) for pulmonary embolism (PE)?

Patient Education for Eliquis (Apixaban) in Pulmonary Embolism

Patients starting Eliquis for PE must understand the critical importance of medication adherence, bleeding risks, and when to seek immediate medical attention, as premature discontinuation significantly increases the risk of recurrent life-threatening blood clots. 1

Dosing Schedule and Adherence

The initial dosing regimen is crucial and differs from long-term therapy:

• First 7 days: Take 10 mg twice daily (morning and evening) 2, 1
• After 7 days: Reduce to 5 mg twice daily for continued treatment 2, 1
• Timing: Take doses approximately 12 hours apart, with or without food 1

If a dose is missed: Take it as soon as remembered on the same day, then resume the regular twice-daily schedule—never double the dose to make up for a missed one 1

Critical warning about stopping medication: Never discontinue Eliquis without consulting your physician, as stopping anticoagulation prematurely dramatically increases the risk of recurrent PE or stroke 1. If Eliquis must be stopped, your doctor will arrange alternative anticoagulation coverage 1.

Bleeding Risk Education

Apixaban causes significantly less major bleeding than traditional warfarin therapy (0.31 times the risk), but bleeding remains the primary safety concern: 2

Signs of Major Bleeding Requiring Emergency Care:

• Unusual bleeding that won't stop
• Coughing up blood or blood clots
• Vomiting blood or material that looks like coffee grounds
• Red or black tarry stools
• Severe headache, dizziness, or weakness
• Unusual bruising or bleeding from gums/nose that doesn't stop 1

Daily Precautions:

• Use a soft toothbrush and electric razor to minimize bleeding risk 2
• Avoid contact sports and activities with high injury risk
• Be cautious with sharp objects (knives, tools)
• Report all falls or head injuries to your physician immediately 1

Drug and Food Interactions

Inform all healthcare providers (including dentists) that you are taking Eliquis before any procedure: 2

Medications to Avoid or Use with Caution:

• NSAIDs (ibuprofen, naproxen, aspirin) increase bleeding risk significantly 1
• Other anticoagulants or antiplatelet agents (clopidogrel, prasugrel)
• Certain antibiotics and antifungals may interact
• Always check with your physician or pharmacist before starting any new medication, including over-the-counter drugs and supplements 2

No dietary restrictions: Unlike warfarin, Eliquis does not require dietary vitamin K restrictions—you can eat normally 2

Procedures and Surgery

Eliquis must be stopped before surgical or invasive procedures: 1

• High bleeding risk procedures: Stop 48 hours before 1
• Low bleeding risk procedures: Stop 24 hours before 1
• Spinal/epidural procedures carry special risks: Inform your anesthesiologist you are taking Eliquis, as spinal hematomas can cause permanent paralysis 1
• Your physician will determine when to safely restart Eliquis after the procedure 1

Duration of Treatment

Most patients require at least 3-6 months of anticoagulation for PE: 2

• Treatment duration depends on whether your PE was provoked (caused by surgery, trauma, immobilization) or unprovoked 2
• Some patients may require indefinite anticoagulation based on recurrence risk 2
• Your physician will reassess at follow-up appointments to determine optimal treatment duration 2

Follow-Up Care

Regular follow-up is essential:

• No routine blood monitoring required (unlike warfarin—no INR checks needed) 2
• Schedule follow-up appointments as directed, typically at 6-12 weeks initially 2
• Report any new symptoms, bleeding episodes, or concerns immediately
• Ensure your primary care physician and all specialists know you are taking anticoagulation 2

Special Situations Requiring Immediate Contact

Call your physician immediately if you experience:

• Any signs of major bleeding (listed above)
• Symptoms of recurrent PE: sudden shortness of breath, chest pain, rapid heart rate
• Symptoms of stroke: sudden weakness, numbness, vision changes, difficulty speaking
• Need for emergency surgery or dental work
• Pregnancy or plans to become pregnant 1

Medication Storage and Refills

• Keep Eliquis at room temperature
• Maintain an adequate supply—do not run out of medication 1
• Set up automatic refills if possible to ensure continuous therapy
• Carry a medication list or medical alert card indicating you take anticoagulation