What Is Eliquis?
Many people don’t think about blood clots on a daily basis, but if you’ve ever had a blood clot, then you know just how scary they can be. Each year, approximately 900,000 cases of potentially deadly blood clots, called deep vein thrombosis, occur in the United States. Blood clots may be provoked, meaning they are associated with known risk factors, or unprovoked, meaning they occur without any identifiable risk factors present. Approximately 274 people die in the United States each day from blood clots, in large part because public awareness of the condition is so low. Fewer than one in four people have any knowledge about blood clots or their signs and symptoms. Patients who do experience blood clots have new options when it comes to treatment, including anticoagulation medications like Eliquis, which can help treat and prevent blood clots.
What Is Eliquis?
Eliquis, known by the generic name apixaban, belongs to a class of drugs called novel oral anticoagulants, also called blood thinners or antiplatelet medications. These medications are factor xa inhibitors and work to block the activity of certain clotting substances in the blood. Eliquis as a brand name was first approved by the U.S. Food and Drug Administration (FDA) in 2012 for use in reducing the risk of stroke and blood clots in patients with nonvalvular atrial fibrillation. The medication received additional FDA approval in 2014 when it was approved to reduce the risk of blood clots following hip replacement or knee replacement surgery and for the treatment of deep vein thrombosis and pulmonary embolism. Eliquis is available by prescription only. The first generic forms of the medication, sold under the name apixaban, were approved in December 2019.
What Is Eliquis Used to Treat?
Eliquis is FDA-approved for three purposes: reduction of the risk of stroke and blood clots in patients with nonvalvular atrial fibrillation, prevention of blood clots and deep vein thrombosis in patients who have had hip or knee replacement surgery, and treatment and prevention of deep vein thrombosis and pulmonary embolism.
Blood Clots and Deep Vein Thrombosis (DVT)
Most of the time, our blood flows smoothly from one part of the body to the other, but when we are injured, the body tells the blood to start clotting in order to prevent us from bleeding to death. Most of the time, this is a good thing, but sometimes blood clots inappropriately inside the body and these clots get stuck in the blood vessels. When a blood clot forms in a deep vein, usually in the legs, pelvis, or arms, it is called deep vein thrombosis. Deep vein thrombosis is a serious condition because the blood clot or part of a clot can break off and travel through the blood vessels towards the lungs or brain. Patients who have experienced one deep vein thrombosis or blood clot are at an increased risk of experiencing future clotting issues. About one out of every three people with deep vein thrombosis will have a recurrence within ten years.
Pulmonary embolism refers to a blood clot that has traveled to the pulmonary arteries in the lungs, usually from deep vein thrombosis. Pulmonary embolism is a life-threatening condition because the clot can reduce or cut off blood supply to the lungs, sometimes causing sudden death. People who have pulmonary embolism commonly experience shortness of breath, a bloody cough, or chest pain, but other symptoms include rapid or irregular heartbeat, lightheadedness or dizziness, excessive sweating, fever, leg pain or swelling, or clammy and discolored skin.
Nonvalvular Atrial Fibrillation
Atrial fibrillation is a medical condition that involves an irregular heart rhythm, and nonvalvular atrial fibrillation is an irregular heartbeat that cannot be attributed to valvular heart diseases, which cause irregularities in the heart valves. Patients with nonvalvular atrial fibrillation are five times more likely to have a stroke or a systemic embolism. This is because patients with nonvalvular atrial fibrillation do not pump blood with a steady beat, which can cause blood to pool in the atrial chambers of the heart, which can lead to blood clots forming in the heart. Over time, a blood clot or a part of a blood clot can break off and travel through the blood vessels to the brain, causing a stroke. Eliquis helps reduce the likelihood of blood clots, thereby reducing the risk of stroke in patients with nonvalvular atrial fibrillation.
How Does Eliquis Work?
Novel oral anticoagulants, like Eliquis, are often called “blood thinners” because they reduce the clotting capacity of the blood in order to lower the chance of blood clot formation. Eliquis works by blocking a blood-clotting protein called Factor Xa, which is critical in the clotting process. By blocking Factor Xa, blood clots more slowly, helping to reduce the incidence of deep vein thrombosis and other blood clots and decrease the likelihood of stroke.
What Are the Benefits of Eliquis?
Blood thinners like Eliquis belong to a new generation of anticoagulants; previously, the only blood thinner available on the market was warfarin (Coumadin). Compared to treatment with Warfarin, Eliquis has numerous benefits, including:
- Eliquis has a reduced risk of major bleeding problems because it wears off more quickly than warfarin
- Patients are not required to take monthly blood tests to ensure that the medication is working
- There are no dietary restrictions associated with taking Eliquis
- There are fewer drug interactions associated with Eliquis as compared to warfarin.
Are There Any Risks Associated with Eliquis?
Eliquis offers a promising new option for patients requiring blood thinners, but there are some risks associated with taking the medication. Risks associated with Eliquis include:
- Patients who take Eliquis may have a higher risk of bleeding when combined with medications like aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen, warfarin, heparin, selective serotonin reuptake inhibitors (SSRIs), or serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as other medications that prevent or treat blood clots like clopidogrel, thrombin, or enoxaparin.
- Patients taking Eliquis may bruise more easily
- Bleeding may take longer to stop when taking Eliquis
- Eliquis increases your risk of severe or fatal bleeding
- The medication should be stopped one to two days prior to having surgery, an invasive procedure, or dental work
- Eliquis can cause a serious blood clot in the spine if a patient receives a spinal puncture or spinal anesthesia while taking the medication
- Patients cannot stop taking Eliquis suddenly due to the increased risk of a blood clot or stroke.
What Dose of Eliquis Do I Take?
Eliquis is offered in 2.5 mg tablets and 5 mg tablets and is taken every twelve hours (twice per day), with or without food. Many doctors recommend mixing the medication into applesauce or apple juice. Following the medication guide, your doctor will prescribe your dose of Eliquis based on the condition being treated, your age, and other medical factors. Often, treatment of existing blood clots or deep vein thrombosis with Eliquis involves taking 5 mg twice per day, while the prevention of blood clots or deep vein thrombosis requires a dose of 2.5 mg taken twice per day. As with many prescription drugs, it is critical that patients who are prescribed Eliquis take their medication as prescribed and avoid missed doses and keep up with their refills, as not doing so can increase your risk of having a stroke or forming a blood clot.
What Are the Side Effects of Eliquis?
Side effects associated with Eliquis are rare but can be potentially serious. The most common side effects associated with Eliquis include easy bruising, unusual bleeding, such as from the nose, mouth, vagina, or rectum, and bleeding from injections. Rare but serious side effects associated with Eliquis include:
- Blood in the eyes
- Bloody or black, tarry stools
- Coughing up blood
- Difficulty swallowing
- Joint pain or swelling
- Redness of the eye
- Trouble breathing and/or wheezing
- Unusual tiredness or muscle weakness
- Blood in the urine
- Bruising or purple areas on the skin
- Decreased alertness
- Fast heartbeat
- Hives, itching, or skin rash
- Nausea and vomiting
- Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- Severe stomach pain
- Tightness in the chest
- Vomiting of blood or material that looks like coffee grounds
Patients should seek medical help immediately and go to the emergency room if they experience any signs or symptoms of bleeding while taking Eliquis, including:
- Unexpected bleeding or bleeding that lasts a long time, including unusual bleeding from the gums, frequent nosebleeds, or vaginal bleeding that is heavier than usual
- Bleeding that is severe or uncontrollable
- Red, pink, or brown urine
- Red or black stools
- Coughing up or vomiting blood
- Vomit that looks like coffee grounds
- Unexpected pain, swelling, or joint pain
- Feeling dizzy or weak
Is Eliquis Safe for Women Who Are Pregnant or Breastfeeding?
Adequate studies and clinical trials regarding the safety of Eliquis for pregnant women have not been conducted. However, due to a high risk of hemorrhage during pregnancy and delivery, Eliquis should be taken only if the potential benefit outweighs the risk to the mother. Breastfeeding mothers should not take Eliquis and breastfeed. Women who are breastfeeding or planning to breastfeed should seek medical advice from their healthcare provider, as Eliquis passes through breast milk and is not considered safe for infants. Women must either stop breastfeeding or stop taking Eliquis.
Who Should Not Take Eliquis?
Eliquis should not be taken by patients with any of the following conditions:
- Have artificial heart valves
- Have certain types of abnormal bleeding
- Have antiphospholipid syndrome (APS), particularly with positive triple antibody testing, with a history of blood clots
- Have had a serious allergic reaction to Eliquis.