Can I stop taking apixaban (apixaban) without consulting my doctor?

No, You Cannot Stop Apixaban Without Consulting Your Doctor

Stopping apixaban without medical supervision significantly increases your risk of stroke, blood clots, and death—you must consult your prescribing physician before discontinuing this medication. 1

Critical Risks of Abrupt Discontinuation

Stroke Risk in Atrial Fibrillation

• If you are taking apixaban for atrial fibrillation, stopping the medication abruptly increases your risk of having a stroke because blood clots can form in your heart and travel to your brain 1
• The FDA drug label explicitly warns: "Do not stop taking apixaban tablets without talking to the doctor who prescribes it for you. Stopping apixaban increases your risk of having a stroke" 1
• Your doctor may need to prescribe another anticoagulant to bridge you if apixaban must be stopped, to prevent clot formation during the transition period 1

Thrombotic Events

• Patients with nonvalvular atrial fibrillation who discontinued apixaban had a 2.00 times higher risk of ischemic stroke (95% CI: 1.03-3.87) compared to those who continued treatment 2
• Discontinuation was associated with a 2.37 times higher risk of venous thromboembolism (95% CI: 1.06-5.27) 2
• All-cause hospitalization risk increased by 23% (HR: 1.23; 95% CI: 1.08-1.40) among discontinuers 2

Mortality Risk

• Patients who discontinued apixaban had a 2.28 times higher risk of death (95% CI: 1.85-2.80) compared to those who continued treatment 2

When Discontinuation May Be Necessary

Surgical or Procedural Requirements

• Apixaban may need to be stopped prior to surgery or medical/dental procedures, but this decision must be made by your prescribing physician in consultation with your surgeon 1
• For high-risk procedures like epidural or spinal anesthesia, apixaban must be stopped at least 5 days before the procedure due to risk of spinal hematoma causing permanent paralysis 3, 4, 1
• For standard high-risk surgeries with normal renal function, cessation 48 hours before the procedure typically results in clinically insignificant anticoagulation levels 3, 5
• Your doctor will tell you exactly when to stop and when to restart apixaban after your procedure 1

Bleeding Complications

• If you experience unexpected bleeding that lasts a long time, severe bleeding you cannot control, or signs of internal bleeding (red/pink/brown urine, black stools, coughing up blood, severe headaches), seek immediate medical attention—but do not stop apixaban on your own 1
• Your physician will determine whether temporary or permanent discontinuation is appropriate based on the bleeding severity and your thrombotic risk 3

Proper Discontinuation Protocol

Medical Supervision Required

• Your prescribing physician must evaluate your individual thrombotic risk (stroke risk from atrial fibrillation, recent VTE, etc.) before discontinuing apixaban 1
• Alternative anticoagulation may be necessary during the discontinuation period, particularly for patients at very high thrombotic risk 3, 4
• Do not run out of apixaban—refill your prescription before it runs out to avoid unintentional gaps in therapy 1

Timing Considerations

• Apixaban has a half-life of approximately 12 hours with normal renal function, meaning the anticoagulant effect diminishes over 2-3 days after the last dose 3, 6
• However, the increased thrombotic risk begins immediately upon discontinuation, particularly in atrial fibrillation patients 2

Common Pitfalls to Avoid

• Never stop apixaban because you're concerned about bleeding risk without discussing with your doctor—the risk of stroke or blood clots from stopping may be greater than your bleeding risk 1, 2
• Do not stop apixaban for minor dental procedures like fillings—these can typically be performed safely while continuing anticoagulation 7
• Do not discontinue apixaban if you fall or injure yourself—instead, call your doctor immediately so they can evaluate whether you need monitoring, but continue taking the medication unless specifically instructed otherwise 1
• Inform all healthcare providers (doctors, dentists, surgeons) that you are taking apixaban before any procedure so they can coordinate with your prescribing physician about proper management 1