Apixaban

What is apixaban?

Apixaban (commonly known under the brand name Eliquis) is an oral anticoagulant. This may also be known as a direct oral anticoagulant (DOAC)[1].  

Apixaban helps to prevent harmful blood clots by blocking a clotting protein in the blood called Factor Xa. It’s commonly used to reduce the risk of stroke in people with certain heart conditions, and to treat or prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). 

What is apixaban used for?

Apixaban is prescribed to prevent stroke and blood clots in people with atrial fibrillation (AF) when it’s not caused by a heart valve problem[1]. It can also be used to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE), especially after surgery. 

How does apixaban work?

Apixaban blocks Factor Xa. This is a key enzyme in the body’s clotting process. By doing so, it slows down the formation of blood clots, reducing the risk of complications such as strokes or embolisms[1]. 

Who can take apixaban?

Apixaban is suitable for most adults. However, it may not be right for everyone, and it might not be appropriate if you have active bleeding or a bleeding disorder. It may also not be appropriate if you have severe liver disease, are pregnant or breastfeeding, or take certain medicines that interact with apixaban[1]. 

Please tell your doctor or pharmacist about any conditions you may have before starting apixaban, and always follow the instructions in the Patient Information Leaflet[2].

How do you take apixaban?

You typically take apixaban twice daily, roughly 12 hours apart. Tablets can be swallowed whole with water, with or without food. Try to take it at the same times each day when possible[1]. 

If you have trouble swallowing, speak to your pharmacist, as the tablets can sometimes be crushed and mixed with water or apple purée. 

What is the usual dose of apixaban?

The typical dose of apixaban is 5mg twice daily. In certain cases, a reduced dose (2.5mg twice daily) may be recommended when treating certain conditions or if two or more of the following apply[1]: 

• You are aged 80 or over 

• You weigh 60 kg or less 

• You have impaired kidney function 

Please speak to your doctor or pharmacist who will decide the correct dose based on your age, weight, and kidney function. 

Can you stop taking apixaban suddenly?

You should not stop taking apixaban without speaking to your doctor or pharmacist[1]. This can significantly increase your risk of severe complications like a stroke or blood clot. If you need to stop taking apixaban for other medical treatments, your doctor or pharmacist will advise you when and how to pause the medicine safely.  

What should you do if you take too much apixaban?

Taking too much apixaban can increase your risk of serious bleeding. If you have taken more than your prescribed dose you should seek urgent medical attention, and do not take any more doses until advised by a healthcare professional[1]. 

What should you do if you forget a dose of apixaban?

If you forget to take a regular dose of apixaban, you should take it as soon as you remember. However, if it has been over 6 hours since the usual time of your dose, skip the missed one then continue with your usual schedule. Don’t take two doses at once[1]. 

Which medicines should you avoid while taking apixaban?

Apixaban can interact with other medications. In some cases, this can increase your risk of bleeding. You should always speak to your doctor or pharmacist before combining apixaban with any other medications, especially[1]: 

• NSAIDs (such as ibuprofen or naproxen) 

• Other anticoagulants (e.g. warfarin, rivaroxaban) 

• Antibiotics  

• Antifungals  

• HIV medicines 

• Herbal products such as St John’s Wort 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2].

What are the side effects of apixaban?

Common side effects include[1]: 

• bruising easily 

• having nosebleeds 

• bleeding gums 

• heavier or prolonged periods 

There is also a chance of experiencing more serious side effects, such as[1]: 

• prolonged or uncontrolled bleeding 

• blood in urine or stools 

• vomiting or coughing up blood 

• severe headaches 

• dizziness 

• signs of internal bleeding.  

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice.

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2].

Frequently asked questions about apixaban

Is apixaban a blood thinner? 

Yes, apixaban is an anticoagulant, which is also known as a blood thinner[1]. 

How long does apixaban take to work? 

Apixaban usually works within a few hours of taking it[1]. 

What will happen if I stop taking it? 

You should not stop taking apixaban without talking to your doctor or pharmacist first. If you stop taking apixaban, the rate at which your blood clots will return to what it was before you started taking it, likely within a day or two of stopping, and and this could increase your risk of stroke, DVT or PE[1]. 

Can I drink alcohol while taking apixaban? 

You can generally drink small amounts of alcohol when taking apixaban. However, excessive drinking can increase your risk of bleeding so you should do so with caution[1]. 

Will I need to carry an anticoagulant alert card with me? 

Yes, you will need to always carry an anticoagulant alert card with you. This is because if you have an accident, it's important that the person treating you knows that you are taking an anticoagulant[1]. 

Do I need regular blood tests while taking apixaban? 

No, in most cases you won’t need regular blood tests while taking apixaban. Unlike warfarin, apixaban does not usually require regular blood tests or INR monitoring[1]. 

Can I have surgery or dental treatment while on apixaban? 

Yes you can usually have surgery or dental treatment while taking apixaban, but you should always inform your surgeon or dentist beforehand. You may need to stop apixaban temporarily before the procedure, needing to do so in a safe and controlled way as advised by your doctor or pharmacist[1]. 

Can lifestyle changes reduce my risk of having a blood clot? 

You can reduce your risk of having a blood clot by making positive lifestyle changes, such as by[1]: 

• Giving up smoking 

• Eating a healthy, balanced diet 

• Regularly exercising 

• Maintaining a healthy weight or losing weight if needed 

Is apixaban safe to take long-term? 

Yes, many people take apixaban long-term, but this should be done under medical supervision[1]. 

For the official NHS guide to apixaban, visit their website.