Does Eliquis Affect Your Red Blood Cells? Understanding the Link to Anemia

October 12, 2025 •

4 min read

Eliquis (apixaban) is a powerful anticoagulant prescribed to prevent and treat dangerous blood clots. As a result of its blood-thinning properties, Eliquis can affect your red blood cells, most notably by increasing the risk of anemia due to internal or external bleeding.

Quick Summary

Eliquis can lead to a decrease in red blood cell count by increasing the risk of bleeding, a known side effect of anticoagulant medications. The drug's primary action is to inhibit clotting factors, not to directly damage red blood cells, but the resulting blood loss can cause anemia. In rare cases, a direct interaction with hemoglobin has also been observed. Proper monitoring and communication with a healthcare provider are essential for managing this risk.

Key Points

Anemia is a Potential Side Effect: One of the most common side effects of Eliquis is anemia, which is a lower-than-normal red blood cell count.
Bleeding is the Cause: The anemia caused by Eliquis is primarily a result of bleeding, which can be minor (e.g., nosebleeds, bruising) or serious (e.g., internal bleeding).
Mechanism is Indirect: Eliquis works by inhibiting Factor Xa to prevent clotting, and does not directly attack or destroy red blood cells.
Some Direct Binding May Occur: Some research has indicated that the drug can bind directly to hemoglobin, the oxygen-carrying protein in red blood cells, although the clinical significance of this is not well understood.
Regular Monitoring is Important: Patients on long-term therapy may require regular blood count monitoring to detect and manage potential anemia.
Watch for Symptoms: Symptoms of anemia, such as unusual fatigue, dizziness, or paleness, should be reported to a healthcare provider.
Managing Risk: Balancing the benefits of preventing dangerous blood clots with the risk of bleeding and anemia is a key aspect of treatment that should be managed by a doctor.

How Eliquis Works: A Quick Overview

To understand how Eliquis can affect your red blood cells, it's important to first know how it functions within the body. Eliquis is a type of medication known as a direct oral anticoagulant (DOAC), specifically a Factor Xa inhibitor. Its primary role is to prevent the formation of new blood clots by blocking Factor Xa, a crucial protein in the blood clotting cascade. By inhibiting this enzyme, Eliquis disrupts the process that leads to the formation of fibrin, the key component of blood clots.

Unlike older anticoagulants like warfarin, Eliquis does not require frequent blood tests to monitor its effect, making it a convenient option for many patients. However, as a blood thinner, it does carry a risk of bleeding, which is the main reason for its indirect impact on red blood cell count.

The Indirect Effect: Bleeding and Anemia

The most common and clinically relevant way Eliquis affects red blood cells is through its main side effect: an increased risk of bleeding. Bleeding can range from minor and noticeable to serious and internal. Any form of significant blood loss can reduce the body's red blood cell count, a condition known as anemia.

Types of Bleeding Linked to Red Blood Cell Reduction

Minor bleeding: Many patients experience minor bleeding events while on Eliquis. These can include frequent nosebleeds, bleeding gums after brushing, or heavier-than-usual menstrual periods. While usually not a cause for alarm in isolation, persistent minor bleeding can lead to a gradual reduction in red blood cells over time.
Bruising and hematomas: Bruising (contusions) and the development of hematomas (collections of blood under the skin) are common side effects. These occur due to blood leaking from small vessels, and while the blood is contained, it still represents a loss from circulation.
Internal bleeding: Serious and less obvious internal bleeding can occur in various parts of the body, such as the digestive tract, brain, or joints. Gastrointestinal bleeding, which can manifest as black, tarry stools, is a noted risk with Eliquis. Internal bleeding, especially when it goes unnoticed, can be a major cause of anemia.
Post-procedural bleeding: After surgery, especially hip or knee replacements for which Eliquis is prescribed, the risk of post-operative hemorrhage or wound secretion can increase, contributing to blood loss.

Symptoms of anemia resulting from Eliquis-related bleeding include fatigue, dizziness, and paleness. If you experience these symptoms, it is crucial to speak with your doctor to determine if they are related to your medication.

A Potential Direct Interaction with Hemoglobin

While the primary link between Eliquis and red blood cells is indirect (via bleeding), one study has explored a more direct, yet uncommon, biochemical interaction. Research has found that apixaban can potentially bind directly to hemoglobin, the protein within red blood cells responsible for carrying oxygen. The study suggested that this binding could affect the drug's free plasma level, though the clinical implications of this interaction are still being evaluated. It is important to reiterate that this is not the main mechanism for how Eliquis impacts red blood cell count; the bleeding risk remains the most significant factor.

Monitoring and Management

For patients on long-term Eliquis therapy, regular monitoring of complete blood counts, including hemoglobin levels, is often recommended, particularly for those with a higher risk of bleeding or existing anemia. A consistent, unexplained decrease in these levels should prompt a thorough investigation for potential bleeding sources.

When a patient develops bleeding or significant anemia, healthcare providers must carefully weigh the benefits of continued anticoagulation against the risks. In cases of severe, life-threatening bleeding, treatment might involve blood transfusions or the use of reversal agents. The decision to adjust or switch medication is a complex one that should always be made in consultation with a medical professional.

Conclusion: How Eliquis Affects Your Red Blood Cells

In summary, Eliquis does affect your red blood cells, primarily as an indirect result of its therapeutic action as an anticoagulant. By preventing blood from clotting, it increases the risk of bleeding, which can lead to anemia. While a potential direct interaction with hemoglobin has been observed in some studies, the most significant risk to your red blood cell count comes from blood loss. Regular monitoring and vigilance for any signs of bleeding or fatigue are essential for patients taking this medication. Always maintain open communication with your healthcare provider to ensure safe and effective management of your treatment.

Comparison: Eliquis vs. Other Anticoagulants Regarding Blood Cells


Feature	Eliquis (Apixaban)	Warfarin (Vitamin K antagonist)	Rivaroxaban (Factor Xa inhibitor)
Mechanism of Action	Inhibits Factor Xa, which decreases thrombin generation.	Interferes with vitamin K-dependent clotting factors.	Inhibits Factor Xa, similar to Eliquis.
Effect on Red Blood Cells	Indirectly reduces count by increasing bleeding risk leading to anemia.	Indirectly reduces count by increasing bleeding risk leading to anemia.	Indirectly reduces count by increasing bleeding risk leading to anemia, potentially with a higher GI bleeding risk than Eliquis.
Monitoring	No routine monitoring required, but complete blood counts may be checked periodically.	Requires frequent monitoring of INR levels to ensure proper dosage.	No routine monitoring required, but periodic kidney function checks are important.
Direct Effect on Cells	Potential binding to hemoglobin observed in one study, but clinical relevance is not confirmed.	No known direct effect on red blood cells outside of bleeding risk.	No known direct effect on red blood cells outside of bleeding risk.
Platelet Effect	No direct effect on platelet aggregation, but indirect inhibition occurs.	No direct effect on platelet function.	No known direct effect on platelet function.

Frequently Asked Questions

Yes, Eliquis can cause anemia. This is a recognized side effect resulting from the increased risk of bleeding associated with the medication. Any blood loss, whether minor or major, can lead to a decrease in red blood cell count and, over time, cause anemia.

Eliquis doesn't directly destroy red blood cells. Instead, its blood-thinning properties increase the risk of bleeding. This blood loss, which can be internal or external, reduces the body's overall red blood cell count, leading to anemia.

Symptoms of anemia include fatigue, weakness, dizziness, and a fast heartbeat. A noticeable paleness in the skin can also occur. For some, internal bleeding might manifest as blood in the urine or dark, tarry stools.

If you have pre-existing anemia, your doctor will need to carefully weigh the risks and benefits of taking Eliquis. The medication may worsen your condition by increasing the risk of bleeding. Regular monitoring and close medical supervision are essential.

The primary effect of Eliquis on hemoglobin is an indirect reduction caused by blood loss. However, one study suggested a potential direct binding between apixaban and hemoglobin, which might affect drug levels, though the clinical significance of this is not yet clear.

For patients on long-term Eliquis therapy, doctors may order periodic complete blood count (CBC) tests, which measure hemoglobin and other blood cell levels. Monitoring for visible signs of bleeding and inquiring about symptoms like fatigue is also a standard practice.

You should not stop taking Eliquis without consulting your doctor. A single, minor nosebleed may not be a cause for concern, but frequent or prolonged bleeding warrants a medical evaluation. Abruptly stopping Eliquis can increase your risk of a dangerous blood clot or stroke.