What is Eliquis (Apixaban)?
Eliquis, with the generic name apixaban, is a prescription medication known as an anticoagulant, or blood thinner [1.2.1]. It belongs to a class of drugs called direct-acting oral anticoagulants (DOACs) that work by inhibiting Factor Xa, a key component in the blood clotting process [1.7.1]. Healthcare providers prescribe Eliquis primarily to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation (a type of irregular heartbeat) [1.6.5]. It's also used to treat and prevent deep vein thrombosis (DVT), which are clots in the legs, and pulmonary embolism (PE), which are clots in the lungs [1.4.4]. Compared to older anticoagulants like warfarin, DOACs such as Eliquis are often preferred because they require less frequent monitoring and may have a lower risk of major bleeding events [1.2.1, 1.7.1].
Common Side Effects
The most common and serious side effect of any anticoagulant, including Eliquis, is bleeding [1.6.2]. This can manifest in various ways, from minor issues like easy bruising and nosebleeds to more severe internal bleeding [1.6.5]. Other reported side effects include nausea, anemia (low red blood cell count), and, in rare cases, allergic reactions [1.6.5]. Hair loss is not listed as a common side effect found during initial clinical trials, but has emerged in post-marketing surveillance [1.2.1, 1.4.1].
Is Hair Loss a Side Effect of Eliquis?
Yes, hair loss (alopecia) might be a side effect of Eliquis, but it is considered uncommon [1.2.1]. While it wasn't a side effect reported in the large clinical trials that led to the drug's approval, cases have been reported since the medication became widely used [1.2.1, 1.4.1]. Pharmacovigilance databases, like the World Health Organization's VigiBase, have recorded reports of alopecia associated with apixaban [1.5.4].
This type of delayed discovery is common for rarer side effects. The data suggests that while a direct causal link is difficult to prove definitively for every case, an association exists between DOACs, including apixaban, and hair loss [1.4.2]. The risk appears lower than with traditional anticoagulants like warfarin and heparin, which have a more established link to hair loss [1.2.1, 1.5.3].
Understanding the Mechanism: How Could Eliquis Cause Hair Loss?
The most likely mechanism for anticoagulant-induced hair loss is a condition called telogen effluvium [1.5.1]. The normal hair growth cycle has three phases:
- Anagen (Growth Phase): Hair is actively growing. This lasts for several years [1.5.1].
- Catagen (Transitional Phase): A short phase where growth stops [1.5.1].
- Telogen (Resting Phase): The hair follicle is at rest for about 3-4 months before the hair is shed [1.5.1, 1.8.3].
Telogen effluvium occurs when a stressor—such as a major illness, surgery, or a new medication—causes a larger than normal number of hair follicles to prematurely shift from the growing (anagen) phase to the resting (telogen) phase [1.5.1, 1.8.5]. This results in diffuse shedding and thinning of hair a few months after the triggering event [1.5.2]. The exact reason anticoagulants trigger this is not fully understood, but it is believed to be related to their therapeutic activity [1.5.1]. One hypothesis suggests it may relate to micro-changes in the blood supply to the hair follicles [1.4.6].
Comparison of Anticoagulants and Hair Loss
All anticoagulants have been implicated in causing hair loss to some extent [1.2.3, 1.5.5]. Reports for older drugs like warfarin and heparin are more numerous, but newer DOACs also have associated cases [1.5.3].
| Anticoagulant | Drug Class | Reported Association with Hair Loss |
|---|---|---|
| Warfarin (Coumadin) | Vitamin K Antagonist | Yes, a known and more frequently reported side effect [1.5.3, 1.5.4]. |
| Heparin | Heparin | Yes, particularly with older, unfractionated heparin [1.5.3, 1.7.6]. |
| Apixaban (Eliquis) | Direct Xa Inhibitor | Yes, reported as an uncommon, post-marketing side effect [1.2.1, 1.5.4]. |
| Rivaroxaban (Xarelto) | Direct Xa Inhibitor | Yes, reports of alopecia exist, similar to other DOACs [1.5.4, 1.7.6]. |
| Dabigatran (Pradaxa) | Direct Thrombin Inhibitor | Yes, reports of alopecia exist in pharmacovigilance databases [1.5.4]. |
What to Do If You Experience Hair Loss on Eliquis
Experiencing hair loss can be distressing, but it is critical to handle it correctly if you are taking a life-saving medication like Eliquis.
- Do Not Stop Taking Eliquis: Abruptly stopping an anticoagulant can significantly increase your risk of a stroke or blood clot, which can be life-threatening [1.6.5]. This is the most important rule.
- Consult Your Healthcare Provider: Schedule an appointment to discuss the hair loss with the doctor who prescribed Eliquis. They can assess the severity and help determine the cause.
- Investigate Other Causes: Hair loss is a common issue with many potential triggers. Your doctor will likely run tests to rule out other causes such as thyroid problems, anemia, nutritional deficiencies (like low iron), hormonal changes, or stress [1.2.1, 1.8.5].
- Discuss Alternatives: If the hair loss is significant and other causes have been ruled out, your doctor may discuss the risks and benefits of switching to a different anticoagulant. In some case reports, switching from one anticoagulant to another has resolved the hair loss [1.5.5, 1.4.3]. However, this is a complex decision that must be made with your doctor.
Conclusion
While the thought of hair loss is concerning, it is an uncommon side effect of Eliquis [1.2.1]. Evidence from post-marketing reports shows that an association exists, likely due to a process called telogen effluvium [1.5.1, 1.4.1]. The risk is generally considered low, especially compared to older anticoagulants [1.2.1]. If you notice hair thinning while on Eliquis, the most crucial action is to consult your healthcare provider for a full evaluation and to never stop the medication on your own [1.6.5].
For more detailed drug information, you can review the manufacturer's patient information or visit the FDA's website.
