Eliquisapixaban

What is Eliquis?

Eliquis is used to prevent stroke and blood clots in adults with non-valvular atrial fibrillation (an irregular heart rhythm). It is also used to treat and prevent deep vein thrombosis (DVT — blood clots in the legs) and pulmonary embolism (PE — blood clots in the lungs), and to prevent blood clots after hip or knee replacement surgery.

How it works

Apixaban directly blocks Factor Xa, a key protein in the blood clotting cascade. By blocking this factor, Eliquis reduces the formation of blood clots without needing to be adjusted as frequently as older blood thinners like warfarin. Unlike warfarin, it does not require routine INR blood tests and has fewer food interactions.

Forms & strengths

Tablets: 2.5 mg and 5 mg. For most indications, the 5 mg twice-daily dose is standard. Dose reduction to 2.5 mg twice daily applies in certain patients (age ≥80, weight ≤60 kg, or creatinine ≥133 micromol/L — must meet at least 2 of these 3 criteria, or for DVT/PE prevention after surgery).

How to take it

Taken twice daily (every 12 hours), with or without food. For atrial fibrillation and DVT/PE treatment: typically 5 mg twice daily (or 2.5 mg twice daily if dose reduction criteria apply). For DVT/PE treatment, an initial higher dose of 10 mg twice daily for 7 days is used. Consistency is important — taking both doses approximately 12 hours apart. If you miss a dose, take it as soon as possible on the same day; do not double up.

Side effects

Common side effects

• Easy bruising — from minor bumps, venipuncture, or blood pressure cuff
• Bleeding gums when brushing teeth
• Nosebleeds that take longer to stop
• Heavier than normal menstrual bleeding
• Blood in urine (pink or red discolouration)
• Small cuts that take longer to stop bleeding

Serious side effects — seek care immediately

• Major bleeding — severe headache, sudden vision changes, coughing or vomiting blood, blood in stool (black, tarry, or bright red stools), prolonged bleeding from cuts — seek emergency care immediately
• Intracranial hemorrhage (brain bleed) — sudden severe headache, weakness on one side, confusion, speech difficulty — call 911
• Spinal or epidural hematoma — if you receive a spinal injection or epidural anaesthesia while on Eliquis, blood can pool around the spinal cord, causing paralysis — report back pain, numbness, or weakness in legs
• Increased stroke risk on abrupt discontinuation — never stop without medical guidance

Important warnings

Who should not take it

• Active bleeding (e.g., active GI bleed, intracranial hemorrhage)
• Severe liver disease (hepatic failure)
• Prosthetic heart valves — warfarin is required for this indication, not DOACs
• Antiphospholipid antibody syndrome (especially triple-positive APS) — warfarin preferred
• Allergy to apixaban

Drug interactions

Aspirin and NSAIDs (ibuprofen, naproxen, diclofenac) increase bleeding risk — avoid regular use; low-dose aspirin (81 mg) is sometimes used with Eliquis by cardiologists but with the understanding of increased bleeding risk. Strong CYP3A4 and P-gp inhibitors (ketoconazole, itraconazole, ritonavir) significantly increase apixaban levels — dose reduction or avoidance may be needed. Strong inducers (rifampin, carbamazepine, St. John's Wort, phenytoin) reduce apixaban levels and may make it less effective — avoid combinations. Dual antiplatelet therapy (aspirin + clopidogrel) with Eliquis carries very high bleeding risk.

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