Does Eliquis increase the risk of bleeding?

October 11, 2025 •

5 min read

According to clinical trial data, Eliquis was associated with a significantly lower rate of major bleeding compared to warfarin in patients with atrial fibrillation. While the risk may be lower than with older anticoagulants, Does Eliquis increase the risk of bleeding at all? The answer is yes, as it is a blood thinner, and understanding this risk is crucial for safe use.

Quick Summary

Eliquis (apixaban) is a blood thinner that increases the risk of bleeding, a known side effect of all anticoagulants. Though safer in many respects than older drugs like warfarin, it still carries potential risks for both minor and serious bleeding events. Safe management involves knowing risk factors, recognizing symptoms of severe bleeding, and following medical advice strictly.

Key Points

Inherent Bleeding Risk: As a blood thinner (anticoagulant), Eliquis naturally increases the risk of bleeding by reducing the blood's ability to clot.
Lower Major Bleeding than Warfarin: Clinical studies have demonstrated that Eliquis is associated with a lower rate of major bleeding, especially intracranial hemorrhage, compared to warfarin.
Common Minor Bleeding: Minor bleeding, such as nosebleeds or bruising, is the most common side effect. It is typically manageable but should be monitored.
Serious Bleeding Signs: Symptoms like red/black stools, vomiting blood, or severe headache indicate serious bleeding and require immediate emergency medical care.
Important Medical History: Factors such as advanced age, kidney or liver disease, and a history of bleeding can increase the risk of bleeding on Eliquis.
Medication Interactions: Taking other medications that affect clotting, such as NSAIDs and certain antidepressants, can further increase your bleeding risk.
Never Stop Abruptly: Discontinuing Eliquis suddenly without medical supervision significantly increases the risk of stroke.
Inform Healthcare Providers: Always tell doctors, dentists, and other healthcare professionals that you are taking Eliquis before any procedure.

Understanding the Mechanism of Eliquis and Bleeding Risk

How Eliquis Works to Prevent Clots

Eliquis, known by its generic name apixaban, is a direct oral anticoagulant (DOAC). It works by selectively inhibiting Factor Xa, a key enzyme in the blood's coagulation cascade. This cascade is a complex series of steps that results in the formation of a blood clot. By blocking Factor Xa, Eliquis effectively prevents the production of thrombin, a substance vital for forming a stable clot. This disruption of the clotting process is beneficial for preventing dangerous clots in conditions like atrial fibrillation or deep vein thrombosis (DVT). However, this is also the fundamental reason it leads to a risk of bleeding, as the body's natural ability to stop bleeding is suppressed.

Types of Bleeding Associated with Eliquis

The bleeding risk with Eliquis can manifest in several ways, ranging from minor and manageable incidents to severe, life-threatening events. Minor bleeding is the most common side effect and may include:

Frequent nosebleeds
Bleeding from the gums when brushing teeth
Bruising more easily than usual
Menstrual periods that are heavier or longer than normal
Small cuts taking longer to stop bleeding

Serious bleeding, though less common, is the most dangerous complication. It can occur internally in the gastrointestinal tract, brain (intracranial hemorrhage), or other organs and requires immediate emergency medical attention.

Comparative Bleeding Risk: Eliquis vs. Other Anticoagulants

Eliquis vs. Warfarin

One of the main reasons for the widespread adoption of DOACs like Eliquis is their improved safety profile compared to older anticoagulants like warfarin. The ARISTOTLE clinical trial famously demonstrated that Eliquis was not only more effective than warfarin in reducing stroke risk in patients with atrial fibrillation but also caused significantly less major bleeding. This reduced risk included fewer intracranial and fatal bleeding events. A major convenience of Eliquis is that it does not require frequent blood monitoring (INR testing) or strict dietary restrictions, which are necessary with warfarin due to its interaction with vitamin K.

Eliquis vs. Other DOACs

Compared to other DOACs, Eliquis also holds up well in terms of safety. For instance, studies comparing Eliquis (apixaban) and Xarelto (rivaroxaban) have indicated that Eliquis may have a slightly lower risk of major bleeding, particularly gastrointestinal bleeding. Similarly, while both Pradaxa (dabigatran) and Eliquis are effective, some research suggests Eliquis may carry a lower risk of overall major bleeding. However, it's worth noting that Pradaxa has a specific reversal agent (Praxbind) available for emergencies, whereas Eliquis uses andexanet alfa, though both are effective. Ultimately, the best anticoagulant for an individual depends on their specific health factors, and a healthcare provider's recommendation is essential.

Comparison of Bleeding Risk Among Anticoagulants


Feature	Eliquis (apixaban)	Warfarin	Xarelto (rivaroxaban)	Pradaxa (dabigatran)
Mechanism	Factor Xa Inhibitor	Vitamin K Antagonist	Factor Xa Inhibitor	Direct Thrombin Inhibitor
Major Bleeding Risk	Generally lower than warfarin and potentially lower than other DOACs like Xarelto.	Higher than Eliquis, especially intracranial hemorrhage.	Potentially higher than Eliquis, especially GI bleeding.	Potentially higher than Eliquis, particularly GI bleeding.
Monitoring	No routine blood monitoring (INR) required.	Requires frequent blood testing (INR).	No routine blood monitoring required.	No routine blood monitoring required.
Dietary Restrictions	None.	Affected by Vitamin K intake.	None.	None.
Reversal Agent	Andexanet alfa available.	Vitamin K, prothrombin complex concentrate.	Andexanet alfa available.	Idarucizumab (Praxbind) available.

Factors That Increase the Risk of Bleeding on Eliquis

Several factors can heighten a patient's risk of bleeding while taking Eliquis, making a thorough medical history review essential before starting treatment. These factors include:

Advanced Age: Older adults, particularly those over 80, are at an increased risk for major bleeding.
Kidney or Liver Disease: Impaired organ function can prevent the body from properly clearing Eliquis, leading to higher drug levels and a greater risk of bleeding.
Concomitant Medications: Taking other drugs that affect blood clotting can significantly increase bleeding risk. These include:
- NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen (Advil) and naproxen (Aleve)
- Aspirin and other antiplatelet agents (e.g., clopidogrel)
- Other anticoagulants (e.g., heparin, warfarin)
- SSRIs and SNRIs (certain antidepressants)
History of Bleeding: A previous history of bleeding episodes, particularly gastrointestinal bleeding, is a strong predictor of future bleeding complications.
Certain Medical Procedures: Undergoing spinal taps, epidurals, or other procedures in the spinal area can lead to a boxed warning risk of spinal or epidural hematoma, which can cause paralysis.
Alcohol Abuse: Excessive alcohol consumption can also increase the risk of bleeding.

Managing Bleeding While on Eliquis

Handling Minor Bleeding

For minor bleeding events, basic first aid measures are often sufficient.

Nosebleeds: Sit or stand upright, lean forward slightly, and pinch the soft part of your nose just above the nostrils for at least 10 minutes. Applying an ice pack to the bridge of your nose can also help.
Cuts: Apply firm, constant pressure with a clean cloth or gauze pad for at least 10 minutes. Elevating the limb can also help.
Bleeding Gums: Use a soft-bristled toothbrush and waxed dental floss. For bleeding, apply pressure with a damp cloth or tea bag.

Recognizing and Responding to Serious Bleeding

Symptoms of serious, potentially life-threatening bleeding require immediate emergency medical attention:

Red, black, or tarry stools
Vomit that is bloody or looks like coffee grounds
Pink, red, or brown urine
Coughing up blood or blood clots
Sudden, severe headache
Unusual pain, swelling, or joint pain
Unexplained dizziness, confusion, or weakness
Any bleeding that is severe or you cannot control

The Role of Reversal Agents

In the event of a severe bleed, an emergency reversal agent can be administered to counteract Eliquis's effects. Andexanet alfa is the approved antidote that can quickly help restore the body's clotting ability. Having access to this treatment option is a significant advancement over older anticoagulants that lack specific, rapid-acting reversal agents.

Important Precautions for Eliquis Users

Before Procedures and Surgeries

Any time you are scheduled for a medical, dental, or surgical procedure, it is vital to inform your healthcare providers that you are taking Eliquis. Depending on the procedure's risk, your doctor will provide specific instructions on when to temporarily stop and restart the medication. Always follow these instructions carefully to manage bleeding risk during and after the procedure.

Do Not Discontinue Abruptly

Never stop taking Eliquis without first consulting your doctor. Abrupt discontinuation of the medication can significantly increase your risk of a thrombotic event, such as a stroke, heart attack, or pulmonary embolism, as the protective effects of the anticoagulant wear off. If Eliquis needs to be stopped for a planned procedure, your doctor may prescribe an alternative anticoagulant during the transition period.

Conclusion: The Balance Between Benefit and Risk

While Eliquis inherently increases the risk of bleeding due to its function as a blood thinner, extensive clinical data confirms its effectiveness and generally lower major bleeding risk compared to warfarin. The decision to use Eliquis is a careful balancing act between the risk of serious thrombotic events (like stroke) and the risk of bleeding. By understanding the medication's mechanism, being aware of risk-increasing factors, and knowing how to respond to bleeding, patients can minimize risks. The benefits of Eliquis in preventing dangerous blood clots, combined with careful patient management, make it a valuable and often safer option than older alternatives for many patients. Patients should always maintain open communication with their healthcare providers to ensure the safest and most effective use of this medication.

Frequently Asked Questions

Eliquis (apixaban) is a Factor Xa inhibitor, which means it blocks a key enzyme in the blood clotting process. By interfering with the body's natural ability to form clots, it increases the risk of bleeding, which can range from minor incidents like nosebleeds to more serious internal bleeding.

No, clinical trials have shown that Eliquis has a significantly lower risk of major bleeding, including life-threatening intracranial bleeding, compared to warfarin. Eliquis also has fewer drug and food interactions, leading to a more stable anticoagulant effect.

Common signs of minor bleeding include frequent nosebleeds, bruising more easily, and bleeding gums. Small cuts may also take longer than usual to stop bleeding. These are generally not a cause for immediate alarm but should be discussed with your doctor if they are frequent or bothersome.

Signs of a serious or severe bleed requiring immediate emergency medical attention include red, black, or tarry stools; vomiting blood or material resembling coffee grounds; red or pink urine; coughing up blood; and severe headaches.

The risk of bleeding on Eliquis can be increased by several factors, including advanced age, kidney or liver disease, a history of bleeding issues, and taking other medications that affect blood clotting, such as NSAIDs (ibuprofen, naproxen) and SSRIs.

Yes, in the event of severe, uncontrollable bleeding, a specific reversal agent called andexanet alfa is available to counteract the blood-thinning effects of Eliquis.

It is crucial to avoid or use caution with medications that can increase bleeding risk when taken with Eliquis. These include NSAIDs, aspirin, other anticoagulants, and certain antidepressants. Always inform your healthcare provider about all medications and supplements you are taking.

If you have a planned medical, surgical, or dental procedure, you must inform your healthcare provider that you are taking Eliquis. They will advise you if and when to temporarily stop the medication to minimize bleeding risk and when it is safe to restart.

No, it is highly unsafe to stop taking Eliquis abruptly without a doctor's guidance. Stopping the medication prematurely can drastically increase your risk of forming a blood clot, leading to a stroke or other serious thrombotic event.