Eliquis, with the generic name apixaban, is a widely prescribed anticoagulant, or blood thinner, used to prevent blood clots in conditions like atrial fibrillation and deep vein thrombosis [1.3.4]. Its primary function is to inhibit Factor Xa, a key component in the body's blood-clotting process [1.10.4]. While effective, a common concern for patients is whether this medication affects the digestive system. The answer is yes; Eliquis can cause a spectrum of gastrointestinal (GI) problems, from mild discomfort to life-threatening bleeding [1.2.1].
Understanding Common vs. Severe GI Side Effects
It is crucial for patients to distinguish between common, manageable side effects and symptoms that indicate a serious medical issue requiring immediate attention.
Common Gastrointestinal Issues
Studies and clinical trials have identified several common GI side effects associated with Eliquis. Nausea is reported as a very common side effect, affecting up to 14.1% of users in some studies [1.2.2, 1.3.3]. Other common issues, occurring in 1% to 10% of patients, include constipation, diarrhea, vomiting, abdominal pain, indigestion (dyspepsia), and gastritis [1.2.2, 1.3.3].
These symptoms can often be managed with simple measures. Taking Eliquis with food or a small snack may help alleviate nausea, and this does not affect the medication's efficacy [1.5.2]. It's also important to stay hydrated [1.5.3]. However, if these symptoms are persistent or severe, consulting a healthcare provider is recommended [1.5.4].
Severe Gastrointestinal Complications: Bleeding Risk
The most significant gastrointestinal risk associated with any anticoagulant, including Eliquis, is bleeding [1.3.4]. Because the medication works by preventing clots, it can also make it harder for the body to stop bleeding, including internally within the GI tract [1.8.1].
Major gastrointestinal bleeding is an uncommon but serious side effect [1.2.2]. Signs of a GI bleed require immediate medical attention and include:
- Vomiting blood or a substance that looks like coffee grounds [1.8.1]
- Red or black, tarry stools (melena) [1.8.1]
- Bright red blood in the stool (hematochezia) [1.2.2]
- Severe stomach pain [1.2.4]
- Dizziness, weakness, or fatigue (which could be signs of blood loss) [1.8.1]
While severe bleeding was rare in clinical trials, the risk is inherent to the medication's mechanism [1.7.3]. The risk may be elevated in certain individuals, such as the elderly or those with pre-existing kidney problems or a history of bleeding stomach ulcers [1.7.3]. It is vital to inform your doctor about all other medications you take, especially nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, as these can also increase bleeding risk [1.2.2].
Managing GI Side Effects
For mild symptoms like nausea or indigestion, taking Eliquis with a meal can be effective [1.5.2]. Staying hydrated and eating smaller, more frequent meals may also help [1.5.3]. It is important to avoid other substances that can irritate the stomach or increase bleeding risk, such as excessive alcohol and certain herbal supplements like St. John's wort [1.2.2].
If you experience any signs of serious bleeding, do not wait. Seek emergency medical help right away [1.8.4]. An antidote called andexanet alfa is available in emergencies to reverse the blood-thinning effects of Eliquis if necessary [1.9.1]. Never stop taking Eliquis without consulting your doctor, as discontinuing the medication prematurely can increase your risk of forming a dangerous blood clot [1.2.3].
Comparison of GI Bleeding Risk: Eliquis vs. Other Anticoagulants
The choice of anticoagulant often involves balancing efficacy against the risk of side effects, particularly GI bleeding. Studies have compared Eliquis (apixaban) to other direct oral anticoagulants (DOACs) and the older anticoagulant, warfarin.
| Medication | Class | Relative Gastrointestinal (GI) Bleeding Risk |
|---|---|---|
| Eliquis (apixaban) | Factor Xa Inhibitor | Generally associated with a lower risk of GI bleeding compared to rivaroxaban and dabigatran [1.4.3, 1.4.5, 1.6.1]. In one study, the rate of overall GI bleeding for apixaban was 2.5 events per 100 person-years [1.6.5]. In a comparison with warfarin, apixaban was associated with a lower risk of major bleeding [1.6.3]. |
| Xarelto (rivaroxaban) | Factor Xa Inhibitor | Consistently associated with a higher risk of GI bleeding compared to both apixaban and warfarin [1.6.1, 1.6.4, 1.6.5]. One study reported a rate of 3.2 events per 100 person-years and found it significantly increased GI bleeding compared to warfarin [1.6.4, 1.6.5]. Another analysis confirmed rivaroxaban had the highest risk of hospitalization for upper GI bleeding among DOACs [1.6.1]. |
| Pradaxa (dabigatran) | Direct Thrombin Inhibitor | Associated with a higher risk of GI bleeding compared to apixaban and warfarin in some studies [1.4.3, 1.6.2]. One analysis noted a standardized 1-year risk of GI bleeding of 6.14% for dabigatran, compared to 3.55% for apixaban [1.4.3]. |
| Warfarin (Coumadin) | Vitamin K Antagonist | Serves as a common baseline for comparison. While some DOACs like rivaroxaban and dabigatran show a higher risk of GI bleeding, apixaban has demonstrated a lower risk of major bleeding overall when compared to warfarin [1.4.2, 1.6.3]. The risk of GI bleeding in new users of DOACs as a class was found to be comparable to that of new warfarin users in one real-world analysis [1.4.4]. |
Conclusion
So, does Eliquis cause gastrointestinal problems? Yes, it is a known side effect. While many patients tolerate Eliquis well, a range of GI issues, from nausea and indigestion to severe bleeding, can occur [1.2.1, 1.2.2]. Patients should be aware of both mild symptoms, which can often be managed at home, and the critical warning signs of a GI bleed that demand immediate medical intervention [1.5.1, 1.8.1]. Compared to other common anticoagulants, apixaban (Eliquis) generally has a more favorable GI safety profile, with a lower risk of bleeding than rivaroxaban and dabigatran [1.10.4]. As with any prescription medication, open communication with your healthcare provider is essential to manage side effects and ensure your treatment is both safe and effective.
For more information, you can consult the official patient information from the manufacturer. ELIQUIS® (apixaban) Official Site
