What to do for hematuria after starting Eliquis (apixaban) for deep vein thrombosis (DVT)?

From the Guidelines

If you're experiencing hematuria (blood in urine) after starting Eliquis (apixaban) for DVT, you should contact your healthcare provider immediately. This is a potentially serious side effect that requires prompt medical evaluation. Do not stop taking Eliquis on your own, as this could increase your risk of blood clots, but your doctor may need to adjust your dosage or switch you to a different anticoagulant. While waiting to speak with your doctor, monitor for other bleeding signs such as unusual bruising, nosebleeds, or blood in stool. Keep track of how much blood is in your urine, when it started, and any associated symptoms like pain or difficulty urinating. Hematuria with Eliquis occurs because the medication works by inhibiting Factor Xa, which reduces blood clotting throughout your body. While this is beneficial for preventing clots in DVT, it can sometimes lead to unwanted bleeding in other areas, including the urinary tract. Your doctor will need to balance the risk of bleeding against the risk of clot progression when determining the best course of action, considering the latest guidelines from Chest, which recommend apixaban, dabigatran, edoxaban, or rivaroxaban over VKA as treatment-phase anticoagulant therapy for patients with acute VTE 1. Some key points to consider include:

• The American Society of Hematology 2020 guidelines for management of venous thromboembolism also provide a conditional recommendation for the use of DOACs over VKAs as treatment for patients with a new diagnosis of VTE 1.
• The choice of anticoagulant should be individualized, taking into account factors such as renal and hepatic function, medication interactions, and patient preference 1.
• For patients with VTE who are treated with VKA, a therapeutic INR range of 2.0-3.0 is recommended 1. In terms of management,
• patients with acute VTE should receive a minimum 3-mo treatment phase of anticoagulation 1.
• extended-phase anticoagulation may be considered for patients with unprovoked VTE or VTE provoked by persistent risk factors 1. Overall, the management of hematuria in patients taking Eliquis for DVT requires careful consideration of the risks and benefits of anticoagulant therapy, and should be guided by the latest evidence-based guidelines and individualized to each patient's needs.

From the Research

Hematuria after starting Eliquis for DVT

• Hematuria, or blood in the urine, can be a side effect of anticoagulant medications like Eliquis (apixaban) 2, 3, 4, 5
• The studies provided do not specifically address the incidence of hematuria in patients taking Eliquis for DVT
• However, the studies do discuss the safety and efficacy of apixaban in the treatment of DVT and pulmonary embolism, as well as its use in special populations 2, 6, 3, 4, 5

Management of Hematuria

• If hematuria occurs after starting Eliquis, it is essential to consult a healthcare provider for proper evaluation and management 3, 4, 5
• The healthcare provider may need to assess the patient's overall condition, including their renal function and bleeding risk, to determine the best course of action 2, 6, 3, 4, 5
• In some cases, the healthcare provider may need to adjust the patient's anticoagulation therapy or add additional medications to manage the hematuria 3, 4, 5

Monitoring and Follow-up

• Patients taking Eliquis for DVT should be monitored regularly for signs and symptoms of bleeding, including hematuria 2, 6, 3, 4, 5
• Regular follow-up appointments with a healthcare provider can help identify any potential issues early on and prevent complications 2, 6, 3, 4, 5