Will I bleed to death from taking Eliquis (apixaban) with Lexapro (escitalopram)?

Bleeding Risk with Eliquis and Lexapro Combination

You will not bleed to death from taking Eliquis (apixaban) with Lexapro (escitalopram), but you do have a modestly increased bleeding risk that requires awareness and monitoring. The combination of an anticoagulant with an SSRI increases bleeding risk, but life-threatening bleeding remains uncommon when these medications are used appropriately 1.

Understanding the Bleeding Risk

The FDA explicitly warns that combining apixaban with SSRIs (like escitalopram) increases bleeding risk because SSRIs affect platelet function 1. However, this does not mean you will experience severe bleeding—it means you need to be vigilant about recognizing bleeding symptoms.

What the Evidence Shows About Bleeding Rates

• In major clinical trials, apixaban demonstrated lower rates of major bleeding and intracranial hemorrhage compared to warfarin in patients with atrial fibrillation 2
• The ARISTOTLE trial showed apixaban had superior safety profiles with reduced bleeding complications compared to traditional anticoagulation 3
• Major bleeding occurred in approximately 2-7% of patients taking apixaban in clinical trials, with most bleeding events being manageable 4, 2
• Fatal bleeding is rare—in cancer patients (a higher-risk population), there were no fatal bleeds with apixaban in one major study 4

Critical Warning Signs to Monitor

You must seek immediate medical attention if you experience any of these bleeding symptoms 1:

• Unusual or prolonged bleeding from gums or frequent nosebleeds
• Red, pink, or brown urine
• Red or black stools (appearing tar-like)
• Coughing up blood or blood clots
• Vomiting blood or vomit that looks like coffee grounds
• Severe headaches, dizziness, or weakness
• Unexpected pain, swelling, or joint pain
• Heavier than normal menstrual or vaginal bleeding
• Bleeding that you cannot control

Risk Mitigation Strategies

Medication Considerations

• Inform all healthcare providers (including dentists) that you take both apixaban and escitalopram before any procedure 1
• Avoid additional bleeding risk medications unless specifically approved by your prescribing physician, including 1:
  • Aspirin or aspirin-containing products
  • NSAIDs (ibuprofen, naproxen) for chronic use
  • Other anticoagulants or antiplatelet agents

Kidney Function Monitoring

• Patients with reduced kidney function have higher apixaban levels and increased bleeding risk 5
• Your creatinine clearance should be monitored, as dose adjustments may be needed if CrCl is reduced 4

Procedure Planning

• Apixaban must be stopped at least 3 days before high bleeding-risk procedures if your kidney function is normal (CrCl >30 mL/min) 4, 6
• Never stop apixaban without consulting your prescribing physician, as this dramatically increases stroke risk 1
• For very high-risk procedures (neurosurgery, spinal procedures), apixaban may need to be stopped up to 5 days in advance 4

Special Populations at Higher Risk

Elderly patients (>75-80 years) may be more susceptible to adverse effects from this drug combination 5. Additionally, patients with:

• Gastrointestinal conditions have higher bleeding risk with apixaban 4
• Antiphospholipid syndrome should not take apixaban due to increased clotting risk 1

The Bottom Line on Safety

The combination is used safely in clinical practice when properly monitored. The key is:

• Recognizing early bleeding symptoms and seeking prompt medical attention 1
• Avoiding additional bleeding-risk medications without medical approval 1
• Never discontinuing apixaban abruptly, as stroke risk increases dramatically 1
• Maintaining regular follow-up with your prescribing physician

Most patients taking this combination do not experience major bleeding, but awareness and appropriate monitoring are essential for safe use 3, 2.