What type of bleeding can Eliquis cause?

October 11, 2025 •

4 min read

Clinical trials show that minor bleeding is the most common side effect for patients taking Eliquis. It is a powerful anticoagulant that works by inhibiting Factor Xa, which is why understanding what type of bleeding can Eliquis cause is essential for patients and caregivers.

Quick Summary

Eliquis (apixaban) can cause various types of bleeding, ranging from minor, frequent issues like nosebleeds and bruising to severe, life-threatening complications such as internal and intracranial hemorrhages. Patient awareness and prompt medical attention are crucial for managing bleeding risks associated with this medication.

Key Points

Two Types of Bleeding: Eliquis can cause both minor bleeding, which is common, and serious internal bleeding, which is rare but life-threatening.
Common Minor Bleeds: Frequent side effects include easy bruising, nosebleeds, bleeding gums, and heavier menstrual periods.
Serious Internal Bleeds: Severe bleeding events can involve the gastrointestinal tract, brain, or spinal column and require immediate emergency care.
Watch for Emergency Signs: Seek help immediately for signs of severe bleeding like bloody or tarry stools, vomiting blood, sudden severe headache, or unusual weakness.
Inform All Healthcare Providers: Always tell doctors, dentists, and specialists that you are on Eliquis before any procedure.
Avoid Certain Medications: Concurrent use of other blood thinners, including over-the-counter NSAIDs like aspirin and ibuprofen, significantly increases the risk of bleeding.
Reversal Agent Available: In life-threatening emergencies, a reversal agent called andexanet alfa can be used to stop Eliquis's effect.

As a direct oral anticoagulant (DOAC), Eliquis (apixaban) is prescribed to prevent and treat dangerous blood clots in patients with conditions like atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE). By inhibiting Factor Xa, a key protein in the blood clotting cascade, Eliquis effectively reduces the risk of clots. However, this same mechanism increases the potential for bleeding, which can range from a minor inconvenience to a serious, life-threatening emergency. Patient education on recognizing and managing these risks is critical.

Types of Bleeding with Eliquis

Eliquis can cause bleeding in many parts of the body, and the severity can vary significantly. Bleeding events are classified as minor or serious.

Minor Bleeding (Very Common)

Minor bleeding is the most frequently reported side effect of Eliquis. While typically not medically serious, patients should still inform their healthcare provider if they experience it consistently.

Bruising: It is common for individuals to bruise more easily and for bruises to be larger or take longer to fade.
Nosebleeds: Occasional nosebleeds, especially if they last for less than 10 minutes, are a common symptom.
Bleeding Gums: Gums may bleed more easily, particularly when brushing or flossing. Using a soft-bristled toothbrush can help.
Heavier Menstrual Periods: Women may experience menstrual bleeding that is heavier or lasts longer than usual.
Prolonged Bleeding from Cuts: Minor cuts may take longer than normal to stop bleeding. Applying firm, continuous pressure is the recommended approach for these small wounds.

Serious and Potentially Fatal Bleeding (Rare)

While rare, serious bleeding events can occur and require immediate medical attention. The possibility of internal bleeding is a significant risk associated with Eliquis.

Gastrointestinal (GI) Bleeding: Bleeding can occur anywhere in the digestive tract, from the stomach to the intestines. Signs include:
- Vomiting blood or material that looks like "coffee grounds"
- Passing red, bright red, or black, tarry stools
Intracranial Hemorrhage (ICH): This is bleeding within the brain and represents one of the most dangerous potential side effects. Symptoms may resemble a stroke and include:
- Sudden, severe headache unlike any experienced before
- Dizziness, confusion, or weakness
- Changes in vision or difficulty speaking
Spinal/Epidural Hematoma: The FDA has issued a boxed warning for this risk, which involves blood clots forming around the spine following a spinal or epidural procedure. This can lead to permanent paralysis.
Other Serious Internal Bleeds: Bleeding can also occur in joints, the abdominal cavity, or other internal organs, leading to symptoms like swelling, unexpected pain, or weakness.

Factors Increasing Bleeding Risk on Eliquis

Several factors can increase an individual's risk of bleeding while taking Eliquis. Healthcare providers will assess these when determining treatment.

Concurrent Medications: Taking other drugs that affect blood clotting, including nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen, significantly increases bleeding risk. Other anticoagulants or antiplatelet agents also raise the risk.
Medical Conditions: Certain pre-existing conditions, particularly kidney or liver problems, can affect how the body processes Eliquis, potentially leading to higher drug levels and an increased bleeding risk.
Age: Older adults may be at a higher risk of bleeding due to age-related changes in body function.
Dosage: The Eliquis dosage is crucial for balancing safety and efficacy. Studies have shown higher bleeding risk with higher doses in certain patient groups.

Managing Bleeding and Reducing Risk

Patients can take steps to manage bleeding and communicate effectively with their healthcare team to minimize risks.

For minor bleeding:

Cuts: Apply firm, direct pressure with a clean cloth for at least 10-15 minutes. Elevating the limb can also help.
Nosebleeds: Sit or stand upright, pinch the nostrils together for 10-15 minutes, and lean forward.
Bleeding Gums: Use a soft-bristled toothbrush and waxed floss to be gentler on gums.

For serious bleeding emergencies:

Immediately contact a healthcare provider or go to an emergency department if any signs of serious internal or intracranial bleeding occur.
In life-threatening situations, a reversal agent like andexanet alfa can be administered to counteract Eliquis's blood-thinning effects.

Preventative measures:

Always inform all healthcare providers, including dentists, that you are taking Eliquis before any medical or dental procedure.
Avoid taking over-the-counter NSAIDs or aspirin unless approved by your doctor.
Adopt safety measures, such as removing trip hazards, to prevent falls.
Never stop taking Eliquis without consulting your doctor, as this can increase the risk of dangerous blood clots and stroke.

Eliquis vs. Warfarin: A Bleeding Risk Comparison


Feature	Eliquis (Apixaban)	Warfarin	Reference
Bleeding Risk	Lower risk of major bleeding, including intracranial and GI bleeds.	Higher risk of major bleeding, including intracranial hemorrhage.
Mechanism	Directly inhibits Factor Xa in the coagulation cascade.	Interferes with Vitamin K-dependent clotting factors.
Monitoring	Does not require routine INR blood monitoring.	Requires frequent blood tests (INR monitoring).
Reversal Agent	Andexanet alfa is a specific reversal agent for life-threatening bleeds.	Vitamin K is a readily available reversal agent.
Drug/Food Interactions	Fewer drug interactions and no major dietary restrictions.	Significant interactions with certain foods high in Vitamin K and numerous medications.

Conclusion

While Eliquis is a highly effective anticoagulant with demonstrated safety advantages over older medications like warfarin, it is not without risk. The medication can cause a range of bleeding, from common minor incidents like bruising and nosebleeds to rare but severe internal hemorrhages, including potentially fatal intracranial bleeds. Acknowledging these risks, understanding the signs and symptoms of serious bleeding, and maintaining open communication with healthcare professionals are paramount for managing patient safety while on Eliquis. When taking any anticoagulant, the goal is always to balance the prevention of dangerous blood clots with the management of bleeding risks. This balance is best achieved through informed patient and physician collaboration. For more information on managing medications, visit the American College of Cardiology website.

Frequently Asked Questions

Yes, minor bleeding is a very common side effect of Eliquis. This can include bruising more easily, occasional nosebleeds, or bleeding from the gums. Serious, major bleeding is rare but possible.

Signs of a serious bleed include red, pink, or brown urine; red or black tarry stools; vomiting blood or material resembling coffee grounds; coughing up blood; and severe headaches or unusual swelling or joint pain.

Eliquis can, in rare cases, cause intracranial bleeding (hemorrhage) in the brain. Symptoms include sudden and severe headache, dizziness, weakness, vision changes, or difficulty speaking, and require immediate medical attention.

Eliquis carries a boxed warning regarding the increased risk of forming a spinal or epidural hematoma after certain spinal procedures, such as injections or punctures. This can result in long-term or permanent paralysis.

For minor cuts, apply firm, continuous pressure with a clean cloth for at least 10 minutes. If the bleeding is severe or does not stop, seek immediate medical care.

No, you should not take aspirin, ibuprofen, or other NSAIDs with Eliquis without consulting your healthcare provider. These medications increase the risk of bleeding significantly.

Yes, a specific reversal agent called andexanet alfa is available for emergency situations to counteract the blood-thinning effects of Eliquis.

Clinical studies suggest that Eliquis is associated with a lower risk of major bleeding, including intracranial bleeding, compared to warfarin.