Can I stop taking apixaban (Elequis)?

Can You Stop Taking Apixaban (Eliquis)?

No, you should not stop taking apixaban without first consulting your prescribing physician, as abruptly discontinuing this medication significantly increases your risk of stroke, particularly if you are taking it for atrial fibrillation. 1

Critical Safety Warning

Stopping apixaban without medical guidance creates immediate thrombotic risk:

• For atrial fibrillation patients: Discontinuing apixaban increases your stroke risk because the medication prevents blood clots from forming in the heart that can travel to the brain or other organs. 1
• The FDA 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
• If discontinuation is necessary: Your physician may prescribe bridging anticoagulation or an alternative blood thinner to maintain protection during the transition period. 1

When Temporary Discontinuation May Be Appropriate

There are specific clinical scenarios where your physician may temporarily hold apixaban:

For Surgical or Invasive Procedures

Low-to-moderate bleeding risk procedures (arthroscopy, colonoscopy with biopsy, coronary angiography):

• Stop apixaban 1 day (24 hours) before the procedure, which corresponds to skipping 2 doses. 2, 3
• This achieves minimal residual anticoagulant effect (approximately 2-3 half-lives). 2

High bleeding risk procedures (cardiac surgery, intracranial/spinal surgery, major abdominal surgery):

• Stop apixaban 2 days (48 hours) before the procedure, which corresponds to skipping 4 doses. 4, 2, 5
• This achieves approximately 4-5 half-lives of drug elimination with only 6% residual anticoagulant effect. 5

Neuraxial procedures (spinal or epidural anesthesia):

• Stop apixaban 3 days (72 hours) before the procedure, even with normal renal function, due to catastrophic risk of epidural hematoma. 2, 5

Renal Function Considerations

Your kidney function critically affects how long apixaban stays in your system:

• Normal renal function (CrCl ≥50 mL/min): Follow standard discontinuation timelines above. 4
• Moderate renal impairment (CrCl 30-50 mL/min): Extend interruption periods by 1-3 additional days, as apixaban has 27% renal clearance and accumulates with declining kidney function. 2, 5
• Severe renal impairment (CrCl 15-30 mL/min): Apixaban can still be used at 5 mg or 2.5 mg twice daily based on dose-reduction criteria, but requires even longer discontinuation periods if procedures are needed. 4

Resuming Apixaban After Interruption

After low bleeding risk procedures:

• Resume apixaban at least 24 hours postoperatively once adequate hemostasis is established, using full dose (5 mg twice daily or 2.5 mg twice daily if dose-reduction criteria are met). 2

After high bleeding risk or major surgery:

• Resume apixaban 48-72 hours postoperatively once adequate hemostasis is confirmed. 2, 5
• Consider starting with reduced dose (2.5 mg twice daily) for the first 2-3 days in high thrombotic risk patients, then advance to full therapeutic dosing. 2, 5
• Never resume therapeutic-dose apixaban while an epidural catheter is in place. 2, 5

Critical Pitfalls to Avoid

• Do not use INR or aPTT to guide timing: These tests are inconsistent and unreliable for assessing apixaban's anticoagulant effect. 2
• Do not routinely use bridging anticoagulation: The 2023 ACC/AHA guidelines recommend against bridging during perioperative interruption, as it increases hemorrhagic risk without reducing thrombotic events. 2, 5
• Do not self-discontinue: Always coordinate with your prescribing physician, who will assess your individual stroke risk (using CHA₂DS₂-VASc score for atrial fibrillation patients) and bleeding risk before making discontinuation decisions. 4, 1

Long-Term Discontinuation Considerations

If you are considering permanently stopping apixaban, your physician must reassess:

• Your indication for anticoagulation: Atrial fibrillation with CHA₂DS₂-VASc score ≥2 in men or ≥3 in women typically requires indefinite anticoagulation. 4
• For venous thromboembolism: Provoked VTE may only require 3 months of treatment, while unprovoked VTE often requires indefinite therapy. 4
• Alternative stroke prevention: If apixaban is stopped in atrial fibrillation patients, aspirin provides inferior protection compared to anticoagulation and is generally not recommended as a substitute. 6