What is Eliquis and How Does It Work?
Eliquis, the brand name for apixaban, is a prescription medication known as an anticoagulant, or blood thinner [1.7.2]. It is primarily used to:
- Reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AFib) [1.9.1].
- Treat deep vein thrombosis (DVT) and pulmonary embolism (PE) [1.9.1].
- Prevent DVT and PE in patients who have undergone hip or knee replacement surgery [1.9.1].
Eliquis works as a direct Factor Xa inhibitor [1.4.1]. Factor Xa is a key protein in the blood clotting process. By selectively blocking this factor, Eliquis decreases the production of thrombin, an enzyme that plays a central role in forming blood clots. This action helps prevent dangerous clots from forming or growing, but it also inherently increases the risk of bleeding throughout the body [1.4.5, 1.9.2].
The Link: Can Eliquis Cause Stomach Bleeding?
Yes, Eliquis can cause stomach bleeding, also known as gastrointestinal (GI) bleeding [1.6.3]. Because the medication works by reducing the blood's ability to clot, any injury or underlying condition in the stomach or intestinal lining that might normally be sealed by a small clot can instead continue to bleed. This is the most common serious side effect of all anticoagulant medications [1.5.3, 1.10.2].
Clinical studies have provided data on the incidence of GI bleeding. For example, in the landmark ARISTOTLE trial, the rate of major GI bleeding for patients taking Eliquis was similar to that for patients taking warfarin (0.76% per year vs. 0.86% per year, respectively) [1.3.4]. While some studies suggest certain other newer anticoagulants (DOACs) might have a higher risk of GI bleeding compared to Eliquis, the risk is a known and significant factor for all drugs in this class [1.2.3, 1.2.5].
Signs and Symptoms of Stomach Bleeding
It is crucial for patients taking Eliquis to recognize the signs of stomach or GI bleeding and seek immediate medical attention. Key symptoms include:
- Stool changes: Black, tarry-looking stools or visible red blood in the stool [1.5.2, 1.8.2].
- Vomiting: Vomiting blood, which may be bright red or look like coffee grounds [1.5.5, 1.8.3].
- Abdominal pain: Cramps or pain in the stomach area [1.5.5].
- Systemic symptoms: Feeling dizzy, weak, faint, or tired; shortness of breath; pale skin [1.5.5, 1.8.2].
Who Is at Higher Risk for Bleeding on Eliquis?
Certain factors can increase an individual's risk of experiencing a bleeding event while taking Eliquis. Healthcare providers consider these factors when prescribing the medication. Major risk factors include:
- Advanced Age: Older patients, particularly those over 80, are at a higher risk [1.6.5].
- Kidney Disease: Impaired kidney function can slow the removal of the drug from the body, increasing its effects and bleeding risk [1.6.4].
- History of Bleeding: Previous gastrointestinal ulcers or bleeding events are strong predictors of future bleeding [1.6.5].
- Low Body Weight: Patients weighing 60 kg (132 lbs) or less may be prescribed a lower dose due to increased risk [1.9.4].
- Concomitant Medications: Taking other drugs that also increase bleeding risk significantly elevates the danger. This includes:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve) [1.7.4].
- Aspirin or aspirin-containing products [1.7.4].
- Certain antidepressants, such as SSRIs and SNRIs [1.7.2].
- Other anticoagulants or antiplatelet agents [1.9.2].
Comparison of Bleeding Risk: Eliquis vs. Other Anticoagulants
Here is a comparison based on findings from major clinical trials, primarily the ARISTOTLE trial for Eliquis vs. Warfarin [1.3.3, 1.3.4].
| Feature | Eliquis (Apixaban) | Warfarin (Coumadin) | Other DOACs (e.g., Rivaroxaban) |
|---|---|---|---|
| Mechanism | Direct Factor Xa inhibitor [1.4.1] | Vitamin K antagonist [1.6.5] | Direct Factor Xa inhibitor [1.2.4] |
| Major Bleeding Risk | Significantly lower overall major bleeding risk than warfarin [1.3.3] | Higher overall major bleeding risk than Eliquis [1.3.2] | Risk varies; some studies show higher GI bleeding rates than apixaban [1.2.4]. |
| GI Bleeding Risk | Similar rates of GI bleeding compared to warfarin in the ARISTOTLE trial [1.3.4, 1.3.5] | The historical standard for comparison [1.3.4] | Some research suggests rivaroxaban has a higher rate of GI bleeding than apixaban [1.2.4]. |
| Monitoring | No routine blood monitoring required [1.9.2] | Requires regular INR blood tests [1.6.5] | No routine blood monitoring required [1.4.4]. |
How to Minimize the Risk of Bleeding
Patients can take several proactive steps to manage and minimize the risk of stomach bleeding:
- Avoid Certain Medications: Do not take NSAIDs like ibuprofen or naproxen unless specifically approved by your doctor. Acetaminophen (Tylenol) is often considered a safer option for pain relief [1.7.3]. Always check the ingredients of over-the-counter products [1.7.4].
- Limit Alcohol: Heavy alcohol use can irritate the stomach lining and may have blood-thinning properties, increasing bleeding risk when combined with Eliquis [1.10.2, 1.10.3].
- Inform All Healthcare Providers: Ensure every doctor, dentist, and pharmacist knows you are taking Eliquis before any procedure or new prescription [1.6.2].
- Follow Dosing Instructions: Take Eliquis exactly as prescribed and do not stop taking it without consulting your doctor, as discontinuing it can increase your risk of stroke [1.9.2].
- Be Careful: Use soft-bristled toothbrushes, an electric razor, and exercise caution to avoid cuts and bruises [1.6.2].
What to Do If You Suspect Bleeding
If you experience minor bleeding, such as from a small cut, apply pressure for 10-15 minutes [1.8.4]. However, if you notice any signs of serious bleeding, such as those associated with stomach bleeding, call your healthcare provider or seek emergency medical help right away [1.8.1, 1.8.2]. Do not stop taking your medication unless instructed to do so by a medical professional [1.8.4].
Conclusion
While Eliquis is an effective medication for preventing life-threatening blood clots and strokes, it carries a definite risk of causing stomach bleeding [1.9.2]. This risk is inherent to its function as an anticoagulant. The risk of GI bleeding with Eliquis is comparable to that of warfarin, though its overall risk of major bleeding is lower [1.3.3, 1.3.4]. Patients can manage this risk by being aware of the symptoms, avoiding certain medications like NSAIDs, limiting alcohol, and maintaining open communication with their healthcare team [1.7.4, 1.10.2]. Promptly recognizing and reporting signs of bleeding is essential for safe and effective treatment.
For more information from the manufacturer, visit the official ELIQUIS® (apixaban) website. [1.6.3]
