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Eliquis blood thinner side effects: Effectiveness, Ease of Use, and Satisfaction

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Effectiveness, Ease of Use, and Satisfaction

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Most voted positive review

84 People found this comment helpful

The cost of this medicine is prohibitive!! Stop the expensive tv ads and reduce the price for us patients.

Most voted negative review

14 People found this comment helpful

After my 6th afib bout in 5 years and 4 electro cardioversions my cardiologist suggested cryoablation. My brother had this done over a year ago. I am one of the worst patients he has… I never take my rythmol or Toprol… I can take a years worth of drugs, or get zapped once every 12 months. Anyway this time they put me on eliquis in prep for ablation. My doctor is very popular and its a 7 we…

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Condition: Other EffectivenessEase of UseSatisfaction

Just started this 4 days ago. So far so good and no ED issues.

ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Treatment to Prevent Blood Clots in Chronic Atrial Fibrillation EffectivenessEase of UseSatisfaction

I think this med is dangerous and taken off the market. I had no strength all I could do was sleep. I had hives and my lips swelled up so bad I couldn’t eat also my finger got scratched on a edge on my lawnmower very minor and it took THREE days before I could get it to stop bleeding.

1 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Treatment to Prevent Recurrence of a Clot in a Deep Vein EffectivenessEase of UseSatisfaction

ijus starte this and i havent exsperienced anything yet upset tummy could be not eating im on it for DVT lazyness sitting on my arse to long ill give more ingo it anything else

2 ShapeCreated with Sketch. thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Blood Clot in Lung EffectivenessEase of UseSatisfaction

I’ve been on Eliquis for 4 months now, due to a P.E. My blood clot has left (very grateful for that) However, I have to take medication for 6 months total. Side effects terrible … headaches, shortness of breath, chest pain and joint pain. It made me feel like I had another P.E .. But I don’t want to complain because I am grateful Eliquis saved me!

2 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Blood Clot in a Deep Vein EffectivenessEase of UseSatisfactionShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Treatment to Prevent Blood Clots in Chronic Atrial Fibrillation EffectivenessEase of UseSatisfaction

Given to my mother for Afib; about 2 weeks after taking she had 2 strokes back to back leaving her bedridden. She also had bleeding from the eyes after she came home from having strokes on hospice. I would not recommend this for Afib ever.

2 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Blood Clot in Lung EffectivenessEase of UseSatisfaction

Went in hospital in fall for a hysterectomy… woke up w blood clots in lungs…. after brief hospital stay put me on eliquis 10mg in morning and 10mg in evening…. 3months later they dropped me to 5mg in morning 5mg in evening…. get randomly tired here and there… and get brain fog here and there. Also weird muscle aches in back. Just went for ct 6months later as I was having lung pain again… clots gone. yay! But keeping me on eliquis for preventative… hoping they drop dosage soon. May keep me on for life, not sure u want that. Read More Read Less

2 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch. Report this postFill 3Created with Sketch. Condition: Deep Vein Thrombosis Prevention EffectivenessEase of UseSatisfaction

Swelling in feet, ankles and legs, lost weight and tiredness

1 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Other EffectivenessEase of UseSatisfaction

Been on this for 6 months I get headaches from time to time and also forget a lot of thing from time to time.

2 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Other EffectivenessEase of UseSatisfaction

caused my mother to go blind blood clot in eye

2 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Treatment to Prevent Blood Clots in Chronic Atrial Fibrillation EffectivenessEase of UseSatisfaction

I started taking eliquis 4 yrs ago for AFib now I have short term memory loss; just discovered memory loss is a side effect.

40 ShapeCreated with Sketch. 2 thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Treatment to Prevent Blood Clots in Chronic Atrial Fibrillation EffectivenessEase of UseSatisfaction

I have been taking Eliquis, 5mg two times per day since 02-2018. I was taken to hospital and had mini-stroke. Dr. put me on Eliquis and Clopidogrel. Ihave shortness of breath with Eliquis, overall tiredness. headaches. Bruise very easily. Have to be extremely careful not to cut myself. Cut my arm last July while on vacation. Bought blood stop powder and plenty of bandaids. Took about three days for it to finally stop bleeding. Mostly concerned about shortness of breath. I like to bicycle, work out in the yard. Wonder if others have had these reactions. Read More Read Less

34 ShapeCreated with Sketch. 1 thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Prevention for a Blood Clot going to the Brain EffectivenessEase of UseSatisfaction

Been taking since stroke 2 years ago. Was taking xarelto prior and before that coumanden. No problems. If cost is prohibitive, there is a card you can get online which brings the cost down to $15.00. Have been on blood thinners all my life, without them I would surely die. I do sometime have joint pain, never attributed it to my meds.

4 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Blood Clot in Lung EffectivenessEase of UseSatisfaction

Iâ??ve only been taking for 5 days but so far so good. Iâ??m taking 10mg twice a day for a pulmonary embolism and havenâ??t had any side effects. To be fair though, I currently have a cold so hard to tell if body aches from meds or being sick at moment. Hopefully unrelated. Downside of med is that itâ??s twice a day at same time. Iâ??ll likely be on this Med for a long time so Iâ??ll come back and add review if anything changes.

2 ShapeCreated with Sketch. 1 thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Treatment to Prevent Recurrence of a Blood Clot in the Lungs EffectivenessEase of UseSatisfaction

Since I’ve been taking this I’ve had bad headaches & blurry eyesight, I’m going to let my surgeon know about this tomorrow, the reason I’m on this because I’m in dialysis, and there was blockage on my port, it kept getting blocked, & nothing seemed to keep it going. I’m afraid that this is something I’m going to have to live with. I have an appointment with my eye doctor next week.

3 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Blood Clot in Lung EffectivenessEase of UseSatisfaction

I have been taking this drug for over a year and while it is much better than having to do the blood test with Wafarin, I have noticed severe joint pain, sore feet and overall decreased flexibility in joints and tendons/ligaments. Anyone else have similar symptoms?

7 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Prevention for a Blood Clot going to the Brain EffectivenessEase of UseSatisfaction

On this for just about two weeks. Tired all the time, taking this post stroke and Dr. wanted me to exercise. That’s impossible because I feel exhausted all the time. I’m sure this works well for some people but it is making me very uncomfortable, I have breathing problems especially at night that I never had before and I just feel lethargic. Taking 5 mg twice a day, trying to get my doctor to adjust it. If not I’m going to look for another alternative treatment. It’s not worth living like this.Read More Read Less

7 ShapeCreated with Sketch. 1 thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Treatment to Prevent Blood Clots in Chronic Atrial Fibrillation EffectivenessEase of UseSatisfaction

Started Eliquis 5mg 2x a day. Short after Hive like rash, Then Trouble Breathing and getting my Breath, Just Weak feeling and can not do anything like working in the yard without shortness of breath and feeling weak. Then Blood in STOOL. But Hey…No stroke…Starting Xarelto tomorrow and see what that poison does to me.

55 ShapeCreated with Sketch. 3 thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Blood Clot in Lung EffectivenessEase of UseSatisfaction

I went into the ER for a double pulmonary embolism. I “woke up” 3 weeks later. I was in the hospital for 4 wks., 3 of which I don’t remember. ELIQUIS caused my adrenal glands to hemorrhage which in turn caused damage to my kidneys. I now have Addison’s Disease and stage 3B Kidney Disease. I am no longer employable because of these long term affects and there I nothing I can do about it. So…..Don’t take ELIQUIS it’s not worth the risk!!

5 ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Other EffectivenessEase of UseSatisfaction

Fatigue and lower back pain.

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Possible Side Effects of ELIQUIS® (apixaban)


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Do not stop taking ELIQUIS without talking to the doctor
who prescribed it to you
For patients taking ELIQUIS for atrial fibrillation: stopping ELIQUIS increases your risk of having a stroke.

Talk to your healthcare team before any medical procedures. ELIQUIS may need to be stopped before surgery, or a
medical or dental procedure. Your doctor will tell you when you should stop taking ELIQUIS and when you may start
taking it again.
If you have to stop taking ELIQUIS your doctor may prescribe another medicine to help prevent a blood
clot from forming.

Look out for the following
icons as
you read:

Talk to your
healthcare team

Call a healthcare
provider right away

Helpful information
to remember


What are the possible serious side effects of ELIQUIS?

This is a list of some of the serious side effects of ELIQUIS.

Bleeding

ELIQUIS can cause bleeding, which can be serious, and rarely may lead to death. This is because ELIQUIS is a blood thinner medicine that reduces blood clotting. While taking ELIQUIS, you may bruise more easily and it may take longer than usual for any bleeding to stop.

You may have a higher risk of bleeding if you take ELIQUIS with other medicines that increase your risk of bleeding, such as:

  • Aspirin
  • Nonsteroidal anti-inflammatory
    drugs (called NSAIDs)
  • Warfarin
  • Heparin
  • Selective serotonin reuptake
    inhibitors (SSRIs) or serotonin
    norepinephrine reuptake
    inhibitors (SNRIs)
  • Other medicines to help prevent
    or treat blood clots

Tell your doctor if you take any of these medicines.

Call your doctor or get medical help right away if you have any of these signs or symptoms of bleeding when taking ELIQUIS:

  • Unexpected bleeding or bleeding

    that lasts a long time, such as:

    • Unusual bleeding from
      the gums
    • Nosebleeds that
      happen often
    • Menstrual or vaginal
      bleeding
      that is heavier
      than normal
  • Bleeding that is severe or you cannot control
  • Red, pink, or brown urine
  • Red or black stools
    (looks like tar)
  • Coughing up or vomiting blood
  • Vomit that looks like coffee grounds
  • Unexpected pain, swelling, or joint pain
  • Headaches
  • Feeling dizzy or weak

Spinal or epidural blood clots (hematoma)

People who take ELIQUIS, and have
medicine injected into their spinal or
epidural area, or have a spinal puncture,
have a risk of forming a blood clot that can cause long-term or permanent loss of the ability to move (paralysis).

Your risk of developing a spinal or epidural blood clot is higher if:

  • A thin tube called an epidural catheter
    is placed in your back
    to
    give you
    certain medicine
  • You take NSAIDs or a medicine
    to
    prevent blood from clotting
  • You have a history of difficult or repeated epidural or spinal punctures
  • You have a history of problems with
    your spine, or have had surgery on
    your spine

If you take ELIQUIS and receive spinal anesthesia or a spinal puncture, your doctor should watch you closely for symptoms of spinal or epidural blood clots or bleeding.

Tell your doctor right away if you have any of these signs or symptoms (especially in your legs and feet) when taking ELIQUIS:

A reaction to ELIQUIS itself

A reaction to ELIQUIS can cause hives, rash, itching, and possibly trouble breathing. If you get this reaction, it will usually happen soon after you take a dose of ELIQUIS.

Get medical help right away if you have any of the following symptoms:

  • Sudden chest pain or
    chest tightness
  • Sudden swelling of your face
    or
    tongue
  • Trouble breathing
  • Wheezing
  • Feeling dizzy or faint

Talk to your doctor about any side effect that may be bothering you or that does not go away. These are not all of the possible side effects of ELIQUIS. Call your doctor for medical advice about side effects.

You are encouraged to report any side effects to the FDA at 1-800-FDA-1088. 1-800-FDA-1088.


Who should not take ELIQUIS?

ELIQUIS is not for patients who:

  • have artificial heart valves.
  • have antiphospholipid syndrome (APS),
    especially with positive
    triple antibody testing, who have
    a history of blood clots.
  • currently have certain types of abnormal bleeding.
  • have had a serious allergic reaction
    to ELIQUIS.

What should I discuss with my healthcare team before starting ELIQUIS?

Talk to your healthcare team about the following:

  • If you have antiphospholipid
    syndrome
  • Any other medical conditions
  • If you have ever had
    bleeding problems

Tell your doctor if you are pregnant or breastfeeding, or planning to become pregnant or breastfeed. You and your doctor should decide if you will take ELIQUIS or breastfeed. You should not do both.

Tell your healthcare team about all
of the medications you are taking, including:

  • Prescriptions
  • Over-the-counter medicines

During treatment, make sure you talk to your healthcare team before you begin to take any new medication.


How should I take ELIQUIS?

Take ELIQUIS exactly as prescribed by your doctor.

Twice daily

With or without food

Do not change your dose or stop taking ELIQUIS unless your doctor tells you to.

What if I miss a dose of ELIQUIS?

If you miss a dose of ELIQUIS, take it as soon as you remember, and do not take more than one dose at the same time.

When should I refill my prescription?

If you are taking ELIQUIS for atrial fibrillation, stopping ELIQUIS may increase your risk of having a stroke. Do not
run out of ELIQUIS. Refill your prescription before
you run out.
When leaving the hospital following hip or knee replacement, be sure that
you will have ELIQUIS available to avoid missing any doses.

ELIQUIS is available in two different tablets. Your doctor or healthcare provider will determine what dose is right for you.

2.5 mg tablet

Round, with a pale yellow color

OR

5 mg tablet

Oval, with a pale orange or pink color

Note: Images do not represent actual tablet size.

On one side of each tablet, there is a number indicating the dosage
strength of the tablet (in milligrams).
On the other side, there is a
medication identification number.


What is ELIQUIS?
ELIQUIS is a prescription medicine used to:

Reduce the risk of stroke and
blood clots in people who have
atrial fibrillation (AFib),
a type
of irregular heartbeat,
not caused by a heart valve
problem.

Treat blood clots in the
veins of the legs (deep vein
thrombosis – DVT) or lungs
(pulmonary embolism – PE),
and
reduce the risk of them
occurring again.

Reduce the risk of forming a blood clot in the legs (DVT)
and lungs (PE) of people who have just had hip or knee replacement surgery.

The product information provided in this
site is intended only for residents of the
United States. The products discussed herein may have different product labeling in
different countries.

The health information contained herein is provided for educational purposes only and is not intended to replace discussions with
a healthcare provider. All decisions
regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.

You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. 1-800-FDA-1088.

Eliquis side effects and how to avoid them

Eliquis side effects | Minor vs. severe bleeding | Fatigue | Allergic reactions |  Warnings | Interactions | How to avoid side effects | When to see a doctor | Discontinuing Eliquis | Xarelto vs. Eliquis

Eliquis (apixaban) is a brand-name blood thinner that reduces the risk of a stroke or blood clots in people with a condition known as atrial fibrillation (a type of irregular heartbeat). It also helps reduce blood clots in those who’ve recently had hip or knee replacement surgery. Your healthcare provider may prescribe Eliquis to treat or prevent pulmonary embolism (PE), which are blood clots in the lungs, or deep vein thrombosis (DVT)—blood clots most commonly in the legs. As a blood thinner, Eliquis is associated with some serious side effects. Your healthcare provider will determine whether it’s right for you, but here are some Eliquis side effects to be aware of.

RELATED: What is Eliquis? | Save on Eliquis refills

Common side effects of Eliquis

Eliquis is an FDA approved prescription drug, but some side effects may occur. Common side effects are typically mild and resolve quickly. However, you should speak with your doctor if the following side effects don’t go away:

  • Bruising easily
  • Persistent bleeding (in the case of nosebleeds or minor cuts and scrapes)
  • Nausea
  • Anemia, causing you to feel tired and weak

Serious side effects of Eliquis

The following are severe side effects that require medical attention, according to the manufacturer of Eliquis, Bristol-Myers Squibb:

  • Severe headaches
  • Dizziness
  • Muscle weakness
  • Joint pain
  • Severe, uncontrollable, or unusual bleeding (bleeding gums, frequent nosebleeds, heavier than usual menstrual bleeding)
  • Low platelet levels (thrombocytopenia)
  • Coughing blood
  • Vomiting blood or vomit that looks like coffee grounds
  • Red or black tarry stool
  • Pink, red, or brown urine
  • Hypersensitivity reactions 
  • Low blood pressure
  • Fainting
  • Spinal or epidural blood clots (hematoma)
  • Increased risk of blood clots or stroke if Eliquis is discontinued abruptly

Minor vs. severe bleeding

Because Eliquis doesn’t allow your blood to clot normally, it’s usual for patients to bleed more. Minor bleeding is often harmless and doesn’t require emergency medical attention. If you have a cut that’s bleeding persistently, you can apply a clean cloth over the wound for 10 to 15 minutes. For a nosebleed, try standing upright while pinching your nostrils and leaning forward. 

Although bruises are harmless, they aren’t visually appealing; you can make them less noticeable by applying an ice pack over the affected area.  

One of the most dangerous Eliquis side effects is excessive bleeding, especially if the bleeding is inside the body. This may present as bloody pink/red/brown urine, bloody red/black tarry stool, bloody vomit or vomit that looks like coffee grounds, coughing up blood, prolonged nosebleeds (longer than 10 minutes), and severe headaches. If you experience any of these symptoms after taking Eliquis, contact your doctor immediately.  

Your risk of bleeding is even higher if you take certain medications with Eliquis, such as nonsteroidal anti-inflammatory drugs (NSAIDs). This includes common over-the-counter pain relievers like ibuprofen, aspirin, and naproxen.

General fatigue

Although tiredness wasn’t a reported side effect during clinical trials, several patients report a noticeable lack of energy after taking the drug. The causality is likely due to other possible side effects from taking Eliquis, such as anemia, blood loss, or nausea/vomiting. 

Allergic reactions

Like most medications, a small number of patients may experience an allergic reaction to Eliquis. However, this is generally less than 1% who have been prescribed this medication. Some symptoms of an allergic reaction to Eliquis are:

  • Itchy or irritated skin
  • Hot flashes
  • Hives/skin rash
  • Sudden chest pain/tightness
  • Sudden swelling of face or tongue
  • Feeling dizzy or faint
  • Wheezing
  • Trouble breathing

Life-threatening allergic reactions are seldom but do occur. Severe allergic reactions require emergency medical attention.

Eliquis warnings

Although Eliquis is extremely effective, it’s not suitable for everyone. The drug is only recommended for adults older than 18. Before taking Eliquis, talk to your healthcare provider if you:

  • Previously had an allergic reaction to Eliquis or other similar medications in the past
  • Have an artificial heart valve
  • Are pregnant or trying to conceive a child since Eliquis is harmful to babies
  • Are breastfeeding or plan to breastfeed since it’s unknown if Eliquis passes into breast milk
  • Have been diagnosed with liver problems
  • Are recovering from surgery or a spinal cord injury
  • Have an open wound or an injury that’s currently bleeding a lot
  • Use other medications to prevent blood clotting 
  • Have antiphospholipid syndrome or any other condition that causes blood clots

Is Eliquis safe?

Eliquis is considered a high-alert medicine, which means that it’s safe as long as it’s taken correctly. If mistreated, it can lead to many serious health risks, including stroke and severe bleeding. Therefore, people need to be extremely cautious when taking Eliquis.

Eliquis and a few other medications are a part of a series of direct oral anticoagulants (DOACs). DOACs are meant to be a better alternative to other blood-thinning medications, such as Coumadin (warfarin) since they don’t require as many diet restrictions or monitoring.

However, in some settings, Eliquis, and most DOACs can cause more severe bleeding than warfarin. There haven’t been enough clinical studies to show the chance of serious side effects for those with certain conditions, like hemodialysis.

Is Eliquis hard on the kidneys?

Since only about 25% of Eliquis is broken down by the kidneys, several top heart doctors claim it’s a better alternative to other blood thinners. While this could be good news for older patients with kidney problems, the FDA is still looking into Eliquis to determine all of the effects it has on both the liver and kidneys. Refer to the FDA for more drug information.

Eliquis interactions

Drug interactions can hinder the effectiveness of your medication and increase the chance of severe side effects. The list below only contains some more serious drug-drug interactions with Eliquis. So if you’re taking any medication or supplements not listed below, bring them to your doctor so they can give a thorough recommendation.

Major interactions

These medications can cause harmful side effects when taken with Eliquis. Speak with your doctor for more information if you’re taking:

  • Tipranavir
  • Betrixaban
  • Inotersen
  • Nonsteroidal anti-inflammatory drugs
  • Thrombolytics—drugs that prevent or treat blood clotting

Acute interactions

These medications are never to be taken with Eliquis. Speak with your doctor for more information if you’re taking:

  • Mifepristone
  • Alipogene Tiparvovec

Antiplatelets and Eliquis 

Antiplatelet drugs cause little compounds in your blood called platelets to become less sticky. Although both drugs work to prevent blood clots, their inner-workings are much different. Therefore, patients who take Eliquis along with antiplatelets might experience more severe bleeding. 

Some common antiplatelet drugs are:

  • Aspirin
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)

Herbal supplements and Eliquis

Certain herbal supplements are known to reduce the effects of Eliquis. St John’s wort can reduce the amount of Eliquis in your system, ultimately making the drug less effective. Therefore, most doctors will recommend you stop taking St John’s wort while you take Eliquis. 

Another common herb that could hinder the results from Eliquis is turmeric. Turmeric is a common herbal supplement because of its anti-inflammatory properties. Since several anti-inflammatory medications interact negatively with Eliquis, doctors generally advise patients not to take them while using the drug.

Alcohol and Eliquis

Drinking alcohol (especially binge drinking) is incredibly dangerous while taking Eliquis. The alcohol can amplify the side effects, such as excessive bleeding, and lead to severe health problems. Moderate drinking (one drink per day) won’t likely cause any issues. However, it’s strongly recommended that you do not drink while taking this medication. 

Eliquis and food interactions

Grapefruit: The only food that seems to have a negative interaction with Eliquis is grapefruit. Studies show that if you consume grapefruit or grapefruit juice while taking Eliquis, you have a higher chance of experiencing bruising or bleeding.

Lack of appetite: One significant correlation between Eliquis and food is how it can drastically reduce your appetite. The lack of hunger is usually a result of an upset stomach, diarrhea, or bloating. If you notice a sudden lack of appetite or weight loss after taking Eliquis, consult with your doctor for more information. 

How to avoid Eliquis side effects

  1. It’s best to take Eliquis according to a schedule set by your healthcare provider. In most cases, Eliquis is taken twice daily, with or without food.
  2. Patients are strongly recommended not to change their dose without otherwise being told by their doctor. Sudden changes in dosing can lead to severe and possibly life-threatening side effects. Call your healthcare provider or refer to the medication guide if you miss a dose of Eliquis to find out when to take your next dose.
  3. Inform your pharmacist and healthcare provider of allergies, previous medical conditions, or recent surgeries before taking this medication. Your healthcare provider can inform you about all things to avoid while taking this medication and what warning signs to look out for if your body is having a negative reaction to the drug.

When to see a doctor for Eliquis side effects

While Eliquis is an effective medication, certain side effects will require immediate medical attention. Call your doctor right away if you are experiencing:

  • Severe bleeding that won’t stop
  • Recurring nosebleeds that last longer than 10 minutes
  • Bloody pink, red, or brown urine
  • Bloody or black tarry stool
  • Abnormal vaginal bleeding
  • Bloody or coffee ground-like vomit
  • Potent headaches 
  • Dizziness or fainting
  • Coughing up blood
  • Difficulty breathing

Experiencing any of the above side effects you must contact your doctor immediately and it might also be a good indicator that it’s time to stop taking Eliquis and consider alternative medications, such as warfarin or Heparin.

Can you ever get off Eliquis?

Eliquis is designed to reduce the risk of stroke by preventing blood clots. If you suddenly stop taking it, you are at a higher risk of experiencing a stroke or blood clots. Therefore, you should always consult with your doctor before you stop taking Eliquis. Your doctor will typically prescribe another medication to prevent blood clots. 

Some situations, like an upcoming surgery or dental procedure, might require you to stop taking Eliquis. In that case, your doctor can determine what the best temporary solution is.  

Which is safer: Xarelto or Eliquis?

Xarelto and Eliquis are both quick and effective treatment options for those at risk of blood clotting. However, since they are fast-acting, they also wear off quickly, causing potentially serious complications. Xarelto only requires a single dose each day, where Eliquis requires two, increasing the chance of a missed dose. 

Both medications share similar side effects. The most common similarity is sudden bruising and bleeding. However, Eliquis seems to have a lower risk of bleeding than Xarelto. Since both medications are anticoagulants, they share many of the same interactions with other drugs. Therefore, patients should be cautious when taking other medications with both Eliquis and Xarelto. 

To determine which one is safer, you would need to speak with a healthcare professional. Only they can provide the right medical advice for your condition.

Apixaban: a blood-thinning medicine to treat and prevent blood clots

It’s very important to take apixaban as your doctor has told you.

It’s usual to take it twice a day. Try to take it at the same time every day.

Swallow the tablet with a drink of water. Apixaban can be taken with or without food.

If you have trouble swallowing pills, speak to your doctor or pharmacist.

You can crush apixaban tablets and mix them with water, apple juice or apple purée. Swallow this mixture straight away.

Dosage

Your dose of apixaban depends on why you’re taking it:

  • for people with a heart problem called atrial fibrillation – the usual dose is one 5mg tablet, taken twice a day. But your doctor may prescribe a lower dose of one 2.5mg tablet twice a day if you’re over 80 years old, weigh less than 60kg (9st 6lb), or have kidney disease and are at a higher risk of bleeding.
  • for people who have recently had a blood clot – if you have had a blood clot within the last 6 months, the usual dose is two 5mg tablets, taken twice a day, for the first 7 days. After that, you’ll take one 5mg tablet twice a day.
  • for people taking it to reduce the risk of a future blood clot – if you had a blood clot more than 6 months ago, the usual dose is one 2.5mg tablet, taken twice a day.
  • for people who have had a hip or knee replacement – the usual dose is one 2.5mg tablet, taken twice a day, you’ll usually take your first dose 12 to 24 hours after surgery.

If you’re unsure what dose you need to take, check with your doctor or pharmacist.

What if I forget to take it?

Take your medicine as soon as you remember, unless it’s nearly time for your next dose.

Do not take a double dose to make up for a missed one. Take your next dose at the usual time, and then carry on as normal.

It’s very important that you remember to take apixaban every day.

If you often forget doses, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Ask your doctor or pharmacist for advice straight away, as overdose puts you at risk of bleeding.

How long will I take it for?

How long you need to take apixaban will depend on why you’re taking it.

If you have had knee replacement surgery, you’ll usually take the tablets for 10 to 14 days.

If you have had a hip replacement, you’ll usually take the tablets for 32 to 38 days.

If you have had a blood clot (DVT or pulmonary embolism), you’ll normally take apixaban for at least 3 months.

Depending on what caused the blood clot, you might need to take it for longer.

If you have atrial fibrillation, you might need to take apixaban long term or even for the rest of your life.

Anticoagulant alert card

Your doctor or pharmacist will give you an anticoagulant alert card.

Carry this with you all the time. It tells healthcare professionals that you’re taking an anticoagulant.

This can be useful for them to know in case of a medical emergency.

If you need any medical or dental treatment, show your anticoagulant alert card to the nurse, doctor or dentist.

This includes before you have vaccinations and routine sessions with the dental hygienist.

Your doctor may advise you to stop taking apixaban or reduce your dose for a short time.

Switching from warfarin to apixaban

If you need to switch from warfarin to apixaban, your doctor will advise you when to stop taking warfarin.

This will probably be a few days before you start apixaban.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood’s clotting.

This is to help decide exactly when you should start taking apixaban.

Switching from apixaban to warfarin

If you need to switch from apixaban to warfarin, you may need to take both medicines together for a few days.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood’s clotting.

This is to help decide exactly when you should stop taking apixaban.

Blood Thinner Pills: Your Guide to Using Them Safely

The Agency for Healthcare Research and Quality offers a free booklet and a video about blood thinner medicines. Staying Active and Healthy with Blood Thinners, a 10-minute video, features easy-to-understand explanations of how blood thinners work and why it’s important to take them correctly. Blood Thinner Pills: Your Guide to Using Them Safely, a 24-page booklet, explains how these pills can help prevent dangerous blood clots from forming and what to expect when taking these medicines.

Video—Staying Active and Healthy with Blood Thinners

People often worry about how routine medicines like blood thinner pills will affect their lifestyles. With a few simple steps, taking a blood thinner can be safe and easy. In fact, more than 2 million people take blood thinners every day to keep them from developing dangerous blood clots. Staying Active and Healthy with Blood Thinners is a 10-minute video that shows how small changes in daily routines can help people take blood thinners safely.

What is a blood thinner? What does it do? Why it is helpful? These questions are answered in this video, which features easy-to-understand explanations of how blood thinners work and why it’s important to take them correctly. It also introduces BEST, an easy way to remember how to fit blood thinner medication into daily life.

Be Careful
Eat Right
Stick to a Routine
Test Regularly

Booklet—Blood Thinner Pills: Your Guide to Using Them Safely

Blood Thinner Pills: Your Guide to Using Them Safely is an easy-to-read booklet that educates people about blood thinners. It offers basic information about the medication, including reasons why a clinician might prescribe it. It also includes tips on diet, medicines and foods to avoid, important precautions for some daily activities, and when to seek help.

Select to download print version of the guide [  PDF – 2.43 MB ].

This guide is also available in Spanish [ PDF – 3.15 MB]. 

Contents

About Your Blood Thinner
How to Take Your Blood Thinner
Check Your Medicine
Using Other Medicines
Talk to Your Other Doctors
Possible Side Effects
Stay Safe While Taking Your Blood Thinner
Food and Your Blood Thinner
Blood Tests

 

About Your Blood Thinner

Your doctor has prescribed a medicine called a blood thinner to prevent blood clots. Blood clots can put you at risk for heart attack, stroke, and other serious medical problems. A blood thinner is a kind of drug called an anticoagulant (an-te-ko-AG-u-lent). “Anti” means against and “coagulant” means to thicken into a gel or solid.

Blood thinner drugs work well when they are used correctly. To help you learn about your medicine, your doctor has given you this booklet to read.

Depending on where you receive care, you may be seen by a doctor, nurse, physician’s assistant, nurse practitioner, pharmacist, or other health care professional. The term “doctor” is used in this booklet to refer to the person who helps you manage your blood thinner medicine.

You and your doctor will work together as a team to make sure that taking your blood thinner does not stop you from living well and safely. The information in this booklet will help you understand why you are taking a blood thinner and how to keep yourself healthy. Please take time to read all of the information in this booklet.

There are different types of blood thinners. The most common blood thinner that doctors prescribe is warfarin (Coumadin®, COU-mad-din). Your doctor may also discuss using one of the newer blood thinners depending on your individual situation.

Warning!

Tell your doctor if you are pregnant or plan to get pregnant. Many blood thinners can cause birth defects or bleeding that may harm your unborn child.

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How to Take Your Blood Thinner

Always take your blood thinner as directed. For example, some blood thinners need to be taken at the same time of day, every day.

Never skip a dose, and never take a double dose.

If you miss a dose, take it as soon as you remember. If you don’t remember until the next day, call your doctor for instructions. If this happens when your doctor is not available, skip the missed dose and start again the next day. Mark the missed dose in a diary or on a calendar.

A pillbox with a slot for each day may help you keep track of your medicines.

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Check Your Medicine

Check your medicine when you get it from the pharmacy.

  • Does the medicine seem different from what your doctor prescribed or look different from what you expected?
  • Does your pill look different from what you used before?
  • Are the color, shape, and markings on the pill the same as what you were given before?

If something seems different, ask the pharmacist to double check it. Many medication errors are found by patients.

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Using Other Medicines

Tell your doctor about every medicine you take. The doctor needs to know about all your medicines, including medicines you used before you started taking a blood thinner.

Other medicines can change the way your blood thinner works. Your blood thinner can also change how other medicines work.

It is very important to talk with your doctor about all the medicines you take, including other prescription medicines, over-the-counter medicines, vitamins, and herbal products.

Products that contain aspirin may lessen the blood’s ability to form clots and may increase your risk of bleeding when you also are taking a blood thinner. If you are taking a blood thinner, talk to your doctor before taking any medication that has aspirin in it.

Medicines you get over the counter may also interact with your blood thinner. Following is a list of some common medicines that you should talk with your doctor or pharmacist about before using.

Pain relievers, cold medicines, or stomach remedies, such as:

  • Advil®
  • Aleve®
  • Alka-Seltzer®
  • Excedrin®
  • ex-lax®
  • Midol®
  • Motrin®
  • Nuprin®
  • Pamprin HB®
  • Pepto Bismol®
  • Sine-Off®
  • Tagamet HB®
  • Tylenol®

Vitamins and herbal products, such as:

  • Centrum®, One a Day®, or other multivitamins.
  • Garlic.
  • Ginkgo biloba.
  • Green tea.

Talk to your doctor about every medication and over-the-counter product that you take.

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Talk to Your Other Doctors

Because you take a blood thinner, you will be seen regularly by the doctor who prescribed the medicine. You may also see other doctors for different problems. When you see other doctors, it is very important that you tell them you are taking a blood thinner. You should also tell your dentist and the person who cleans your teeth.

If you use different pharmacies, make sure each pharmacist knows that you take a blood thinner.

Blood thinners can interact with medicines and treatments that other doctors might prescribe for you. If another doctor orders a new medicine for you, tell the doctor who ordered your blood thinner because dose changes for your blood thinner may be needed.

Tell all your doctors about every medication and over-the-counter product that you take.

Tell your doctor about all your medicines.

Always tell your doctor about all the medicines you are taking. Tell your doctor when you start taking new medicine, when you stop taking a medicine, and if the amount of medicine you are taking changes. When you visit your doctor, bring a list of current medicines, over-the-counter drugs—such as aspirin—and any vitamins and herbal products you take. A personal, medication wallet card can help you keep track of this list. Go to www.ahrq.gov/yourmedicine/ to download a printable wallet card that you can use to record the medicine and other products that you take.

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Possible Side Effects

When taking a blood thinner it is important to be aware of its possible side effects. Bleeding is the most common side effect.

Call your doctor immediately if you have any of the following signs of serious bleeding:

  • Menstrual bleeding that is much heavier than normal.
  • Red or brown urine.
  • Bowel movements that are red or look like tar.
  • Bleeding from the gums or nose that does not stop quickly.
  • Vomit that is brown or bright red.
  • Anything red in color that you cough up.
  • Severe pain, such as a headache or stomachache.
  • Unusual bruising.
  • A cut that does not stop bleeding.
  • A serious fall or bump on the head.
  • Dizziness or weakness.

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Stay Safe While Taking Your Blood Thinner

Call your doctor and go to the hospital immediately if you have had a fall or hit your head, even if you are not bleeding. You can be bleeding but not see any blood. For example, if you fall and hit your head, bleeding can occur inside your skull. Or, if you hurt your arm during a fall and then notice a large purple bruise, this means you are bleeding under your skin.

Because you are taking a blood thinner, you should try not to hurt yourself and cause bleeding. You need to be careful when you use knives, scissors, razors, or any sharp object that can make you bleed.

You also need to avoid activities and sports that could cause injury. Swimming and walking are safe activities. If you would like to start a new activity that will increase the amount of exercise you get every day, talk to your doctor.

You can still do many things that you enjoy. If you like to work in the yard, you still can. Just be sure to wear sturdy shoes and gloves to protect yourself. If you like to ride your bike, be sure you wear a helmet.

Tell others.

Keep a current list of all the medicines you take. Ask your doctor about whether you should wear a medical alert bracelet or necklace. If you are badly injured and unable to speak, the bracelet lets health care workers know that you are taking a blood thinner.

To prevent injury indoors:

  • Be very careful using knives and scissors.
  • Use an electric razor.
  • Use a soft toothbrush.
  • Use waxed dental floss.
  • Do not use toothpicks.
  • Wear shoes or non-skid slippers in the house.
  • Be careful when you trim your toenails.
  • Do not trim corns or calluses yourself.

To prevent injury outdoors:

  • Always wear shoes.
  • Wear gloves when using sharp tools.
  • Avoid activities and sports that can easily hurt you.
  • Wear gardening gloves when doing yard work.

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Food and Your Blood Thinner

If your doctor has prescribed warfarin, the foods you eat can affect how well your blood thinner works for you. High amounts of vitamin K can work against warfarin. Other blood thinners are not affected by vitamin K. Ask your doctor if your diet can affect how well your blood thinner works.

For a list of foods that contain vitamin K, go to www.usda.gov and search for vitamin K.

If you are taking a blood thinner, you should avoid drinking alcohol.

Call your doctor if you are unable to eat for several days, for whatever reason. Also call if you have stomach problems, vomiting, or diarrhea that lasts more than 1 day. These problems could affect your blood thinner dose.

Keep your diet the same.

Do not make any major changes in your diet or start a weight loss plan unless you talk to your doctor first.

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Blood Tests

You will have to have your blood tested often if you are taking warfarin. The blood test helps your doctor decide how much medicine you need.

The International Normalized Ratio (INR) blood test measures how fast your blood clots and lets the doctor know if your dose needs to be changed. Testing your blood helps your doctor keep you in a safe range. If there is too much blood thinner in your body, you could bleed too much. If there is not enough, you could get a blood clot.

Regular blood tests are not needed for some of the newer blood thinners.

Too Little Best Range Too much
May cause a blood clot   May cause bleeding
Important reminders:

  • Take your blood thinner as directed by your doctor.
  • Go for blood tests as directed.
  • Never skip a dose.
  • Never take a double dose.

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This booklet is based on a product developed by Carla Huber, A.R.N.P., M.S., Cedar Rapids Community Anticoagulation Clinic, Cedar Rapids, Iowa, under AHRQ Grant No. 1 U18 HSO15830-01 to Kirkwood Community College.

This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated.

The name of my blood thinner is: _______________________________

Reminders:

Call your doctor or pharmacy if you have questions about your blood thinner.

  • My doctor’s contact information is:
    _________________________________________
  • My pharmacist’s contact information is:
    _________________________________________

Notes:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________
 

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The Need-to-Know Side Effect of Blood Thinners

1. Follow your treatment plan to a T. Be sure you’re taking your medication exactly as directed by your doctor. If you don’t take enough of the blood thinner, it might not be able to prevent a clot. But if you take too much, it can increase your risk for bleeding even further, according to the American Heart Association (AHA). Typically, the AHA recommends that people on blood thinners should have their blood monitored on a monthly basis.

2. Avoid taking drugs that can increase your risk of heavy bleeding. That includes non-steroidal anti-inflammatory drugs (NSAIDs) like Advil and Motrin (ibuprofen), and Aleve (naproxen), says Marcelo Gomes, MD, associate staff member in the section of vascular medicine at the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Sydell and Arnold Miller Family Heart & Vascular Institute of the Cleveland Clinic in Ohio. Some supplements also can increase your risk of bleeding, says Dr. Gomes. St. John’s wort is one; there’s also some concern that high doses of omega-3 supplements can make blood thinners more potent, according to the Cleveland Clinic. If you haven’t done so already, tell your doctor about every dietary supplement you are currently using and consult with him or her before taking any new ones — even if those products are labeled as “safe” or “all natural.”

3. Pay extra attention to your diet. If you’re taking blood thinners, you shouldn’t make any major dietary changes without talking to your doctor first. You’ll also want to avoid eating too much vitamin K, which is found in foods such as asparagus, broccoli, and leafy greens like kale. (The vitamin encourages blood clotting and can interfere with the actions of certain blood thinners like warfarin, according to the U.S. National Library of Medicine.) You should also steer clear of cranberries and alcohol, which can enhance the effects of blood thinners and further increase your risk for bleeding, says Dr. Gomes.

RELATED: The Best Diet to Prevent a Stroke

4. Avoid taking any physical risks. This isn’t the time to organize a rugby league. “Generally, patients should avoid any activity that may result in frequent or potentially serious trauma, such as skiing and contact sports,” says Gomes. “No bungee jumping or sky diving.” And even when you’re participating in low-risk sports, you should always wear proper safety gear, like a helmet and gloves.

5. Be more cautious in general. It’s smart to avoid any abrasive or sharp objects, according to the National Blood Clot Alliance (NBCA). For example, choose soft-bristle toothbrushes and shoes that don’t hurt your feet. And be careful when you’re using razors, scissors, and your favorite paring knife.

6. Don’t wait to seek help. If you do fall or sustain an injury, especially a blow to the head, don’t hesitate to go to the doctor’s office or even the emergency room if necessary, says Dr. Haut.

How to Tell If the Bleeding Is an Emergency  

When you’re taking a blood thinner, says Gomes, you may bruise more easily and may also notice bleeding around your gums after brushing your teeth. In most cases, bleeding caused by blood thinners is not serious, according to the NBCA. If you get a minor cut while working in the yard or the kitchen, the bleeding might last longer than usual. You could also experience frequent nosebleeds that last for several minutes. Though frustrating and inconvenient, these occurrences aren’t life-threatening.

However, blood thinners can cause dangerous bleeding that requires immediate medical attention, says Gomes. Major bleeding complications include internal bleeding in the stomach, bowel, or brain, he says. “This could be life-threatening,” he adds. “Intracranial hemorrhage is the most feared complication.”  And, Haut notes, the damage caused by bleeding in the brain may be irreversible.

So, in addition totaking steps to prevent bleeding, it’s also important to recognize the warning signs of this potentially serious side effect:

  • Excessive menstrual bleeding
  • Coughing up anything red in color
  • Severe headache or stomachache
  • Dizziness or weakness
  • Blood in the urine or bowel movements

Eliquis (apixaban) dosing, indications, interactions, adverse effects, and more

  • abametapir

    Serious – Use Alternative (1)abametapir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

  • abciximab

    Serious – Use Alternative (1)abciximab and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • acalabrutinib

    Monitor Closely (1)acalabrutinib increases effects of apixaban by anticoagulation. Use Caution/Monitor. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding.

  • alteplase

    Serious – Use Alternative (1)alteplase and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • anagrelide

    Serious – Use Alternative (1)anagrelide and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • antithrombin alfa

    Serious – Use Alternative (1)antithrombin alfa and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • apalutamide

    Serious – Use Alternative (1)apalutamide will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

  • argatroban

    Serious – Use Alternative (1)argatroban and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • aspirin

    Monitor Closely (1)aspirin and apixaban both increase anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding. The need for simultaneous use of low-dose aspirin (

  • atazanavir

    Serious – Use Alternative (1)atazanavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • belzutifan

    Monitor Closely (1)belzutifan will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

  • berotralstat

    Monitor Closely (1)berotralstat will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

  • betrixaban

    Contraindicated (1)apixaban, betrixaban.
    Either increases levels of the other by anticoagulation. Contraindicated. Therapeutic duplication; may use temporarily when switching anticoagulants.

  • bivalirudin

    Serious – Use Alternative (1)bivalirudin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • caplacizumab

    Monitor Closely (1)caplacizumab, apixaban.
    Either increases effects of the other by anticoagulation. Use Caution/Monitor.

  • carbamazepine

    Contraindicated (1)carbamazepine will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

  • celecoxib

    Serious – Use Alternative (1)celecoxib and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • cenobamate

    Monitor Closely (1)cenobamate will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

  • cilostazol

    Serious – Use Alternative (1)cilostazol and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • citalopram

    Monitor Closely (1)citalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • clarithromycin

    Minor (1)clarithromycin will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Although clarithromycin is a combined P-gp and strong CYP3A4 inhibitor, the manufacturer has stated that pharmacokinetic data suggest that no dose adjustment is necessary with concomitant administration

  • clopidogrel

    Serious – Use Alternative (1)clopidogrel and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • cobicistat

    Monitor Closely (1)cobicistat will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

  • conivaptan

    Serious – Use Alternative (1)conivaptan will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • crofelemer

    Monitor Closely (1)crofelemer increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

  • dabigatran

    Serious – Use Alternative (1)dabigatran and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • dabrafenib

    Monitor Closely (1)dabrafenib will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

  • dalteparin

    Serious – Use Alternative (1)dalteparin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • darunavir

    Serious – Use Alternative (1)darunavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

  • defibrotide

    Contraindicated (1)defibrotide increases effects of apixaban by pharmacodynamic synergism. Contraindicated. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. This does not include use for routine maintenance or reopening of central venous lines.

  • desirudin

    Serious – Use Alternative (1)desirudin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • desvenlafaxine

    Serious – Use Alternative (1)desvenlafaxine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • dexamethasone

    Contraindicated (1)dexamethasone will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

  • diclofenac

    Serious – Use Alternative (1)diclofenac and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • diltiazem

    Monitor Closely (1)diltiazem increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Patients with renal impairment receiving apixaban with drugs that are combined P-gp and weak or moderate CYP3A4 inhibitors may have significant increases in exposure compared with patients with normal renal function and no inhibitor use, since both pathways of apixaban elimination are affected. Since these increases may increase bleeding risk, use apixaban in this situation only if the potential benefit justifies the potential risk.

  • dipyridamole

    Serious – Use Alternative (1)dipyridamole and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • dronedarone

    Monitor Closely (1)dronedarone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dronedarone also inhibits P-gp activity, which can further increase rivaroxaban serum levels; since both pathways of rivaroxaban elimination are affected, patients with renal impairment receiving rivaroxaban with drugs that are combined P-gp and moderate CYP3A4 inhibitors may have significant increases in exposure compared to patients with normal renal function; since the drug combination may increase bleeding risk, monitor closely.

  • duloxetine

    Serious – Use Alternative (1)duloxetine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • edoxaban

    Serious – Use Alternative (1)edoxaban, apixaban.
    Either increases toxicity of the other by anticoagulation. Avoid or Use Alternate Drug. Both drugs have the potential to cause bleeding, monitor closely. Promptly evaluate any signs or symptoms of blood loss. Long-term concomitant treatment with edoxaban and other anticoagulants is not recommended. Short-term coadministration may be needed for patients transitioning to or from edoxaban.

  • efavirenz

    Monitor Closely (1)efavirenz will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • elagolix

    Monitor Closely (2)elagolix will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

    elagolix will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

  • eliglustat

    Monitor Closely (1)eliglustat increases levels of apixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

  • encorafenib

    Monitor Closely (1)encorafenib, apixaban. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

  • enoxaparin

    Serious – Use Alternative (1)enoxaparin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • enzalutamide

    Serious – Use Alternative (1)enzalutamide will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • eptifibatide

    Serious – Use Alternative (1)eptifibatide and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • escitalopram

    Monitor Closely (1)escitalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • etodolac

    Serious – Use Alternative (1)etodolac and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • Factor X, human

    Serious – Use Alternative (1)apixaban will decrease the level or effect of Factor X, human by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Based on the mechanism of action, Factor X is likely to be counteracted by direct and indirect Factor Xa inhibitors.

  • fedratinib

    Monitor Closely (1)fedratinib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

  • fenoprofen

    Serious – Use Alternative (1)fenoprofen and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • fexinidazole

    Serious – Use Alternative (1)fexinidazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

  • fish oil triglycerides

    Monitor Closely (1)fish oil triglycerides will increase the level or effect of apixaban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

  • fluoxetine

    Monitor Closely (1)fluoxetine increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • flurbiprofen

    Serious – Use Alternative (1)flurbiprofen and apixaban both decrease anticoagulation. Avoid or Use Alternate Drug.

  • fluvoxamine

    Monitor Closely (1)fluvoxamine increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • fondaparinux

    Contraindicated (1)fondaparinux and apixaban both increase anticoagulation. Contraindicated. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

  • fosphenytoin

    Contraindicated (1)fosphenytoin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

  • glecaprevir/pibrentasvir

    Monitor Closely (1)glecaprevir/pibrentasvir will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely.

  • heparin

    Serious – Use Alternative (1)heparin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • ibrutinib

    Monitor Closely (1)ibrutinib will increase the level or effect of apixaban by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

  • ibuprofen

    Serious – Use Alternative (1)ibuprofen and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • ibuprofen IV

    Serious – Use Alternative (1)ibuprofen IV and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • idelalisib

    Serious – Use Alternative (1)idelalisib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

  • iloperidone

    Monitor Closely (1)iloperidone increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

  • imatinib

    Monitor Closely (1)imatinib, apixaban.
    Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely.
    Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents; patients requiring anticoagulation while on imatinib should receive LMWH or unfractionated heparin instead of warfarin because of multiple interaction mechanisms of imatinib with warfarin.

  • indinavir

    Monitor Closely (1)indinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • indomethacin

    Serious – Use Alternative (1)indomethacin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • istradefylline

    Monitor Closely (2)istradefylline will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

    istradefylline will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

  • itraconazole

    Monitor Closely (1)itraconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Apixaban is a both CYP3A4 and P-gp substrate. For patients receiving apixaban 5 or 10 mg BID, decrease apixaban dose by 50% when coadministered with drugs that are both P-gp and strong CYP3A4 inhibitors. For patients receiving apixaban 5 mg BID, avoid coadministration with combined P-gp and strong CYP3A4 inhibitors.

  • ivosidenib

    Serious – Use Alternative (1)ivosidenib will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

  • ketoconazole

    Serious – Use Alternative (1)ketoconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

  • ketoprofen

    Serious – Use Alternative (1)ketoprofen and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • ketorolac

    Serious – Use Alternative (1)ketorolac and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • lasmiditan

    Serious – Use Alternative (1)lasmiditan increases effects of apixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

  • levomilnacipran

    Serious – Use Alternative (1)levomilnacipran, apixaban.
    Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.

  • lonafarnib

    Monitor Closely (1)lonafarnib will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.Serious – Use Alternative (1)lonafarnib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

  • lopinavir

    Monitor Closely (1)lopinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • lorlatinib

    Monitor Closely (1)lorlatinib will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • meclofenamate

    Serious – Use Alternative (1)meclofenamate and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • mefenamic acid

    Serious – Use Alternative (1)mefenamic acid and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • melatonin

    Monitor Closely (1)melatonin increases effects of apixaban by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

  • meloxicam

    Serious – Use Alternative (1)meloxicam and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • mifepristone

    Contraindicated (1)mifepristone increases toxicity of apixaban by anticoagulation. Contraindicated.Monitor Closely (1)mifepristone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce apixaban dose by 50% when mifepristone used for treatment of Cushing’s disease or other hormonal conditions; if patients are already receiving 2.5 mg twice daily, avoid coadministration

  • milnacipran

    Serious – Use Alternative (1)milnacipran and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • mitotane

    Monitor Closely (1)mitotane decreases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

  • nabumetone

    Serious – Use Alternative (1)nabumetone and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • naproxen

    Serious – Use Alternative (1)naproxen and apixaban both decrease anticoagulation. Avoid or Use Alternate Drug.

  • nefazodone

    Monitor Closely (1)nefazodone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • nelfinavir

    Serious – Use Alternative (1)nelfinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

  • nintedanib

    Monitor Closely (1)nintedanib increases effects of apixaban by anticoagulation. Use Caution/Monitor. Nintedanib is a VEGFR inhibitor, and may increase the risk of bleeding; monitor patients on full anticoagulation therapy; monitor closely for bleeding and adjust therapy as needed .

  • omacetaxine

    Contraindicated (1)omacetaxine increases toxicity of apixaban by anticoagulation. Contraindicated.

  • oxaprozin

    Serious – Use Alternative (1)oxaprozin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • paroxetine

    Monitor Closely (1)paroxetine increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • phenobarbital

    Serious – Use Alternative (1)phenobarbital will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

  • phenytoin

    Contraindicated (1)phenytoin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

  • piroxicam

    Serious – Use Alternative (1)piroxicam and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • posaconazole

    Serious – Use Alternative (1)posaconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

  • prasugrel

    Serious – Use Alternative (1)prasugrel and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • primidone

    Serious – Use Alternative (1)primidone will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

  • protein C concentrate

    Serious – Use Alternative (1)protein C concentrate and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • prothrombin complex concentrate, human

    Contraindicated (1)apixaban, prothrombin complex concentrate, human. pharmacodynamic antagonism. Contraindicated.

  • quinidine

    Serious – Use Alternative (1)quinidine will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

  • reteplase

    Serious – Use Alternative (1)reteplase and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • ribociclib

    Monitor Closely (1)ribociclib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • rifabutin

    Contraindicated (1)rifabutin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

  • rifampin

    Serious – Use Alternative (1)rifampin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Rifampin, a combined P-gp and strong CYP3A4 inducer, may decrease exposure to apixaban.

  • ritonavir

    Serious – Use Alternative (1)ritonavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

  • rivaroxaban

    Serious – Use Alternative (1)rivaroxaban and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • rucaparib

    Monitor Closely (1)rucaparib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

  • saquinavir

    Serious – Use Alternative (1)saquinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

  • sarecycline

    Monitor Closely (1)sarecycline will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

  • saw palmetto

    Monitor Closely (1)saw palmetto increases toxicity of apixaban by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.

  • secobarbital

    Contraindicated (1)secobarbital will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

  • sertraline

    Monitor Closely (1)sertraline and apixaban both increase anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

  • sotorasib

    Serious – Use Alternative (1)sotorasib will decrease the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

  • St John’s Wort

    Contraindicated (1)St John’s Wort will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

  • stiripentol

    Monitor Closely (2)stiripentol, apixaban. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

    stiripentol will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

  • sulindac

    Serious – Use Alternative (1)sulindac and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • tazemetostat

    Monitor Closely (1)tazemetostat will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • tecovirimat

    Monitor Closely (1)tecovirimat will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

  • tenecteplase

    Serious – Use Alternative (1)tenecteplase and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • tepotinib

    Serious – Use Alternative (1)tepotinib will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

  • ticlopidine

    Serious – Use Alternative (1)ticlopidine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • tipranavir

    Monitor Closely (1)tipranavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • tirofiban

    Serious – Use Alternative (1)tirofiban and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • tolmetin

    Serious – Use Alternative (1)tolmetin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • tucatinib

    Monitor Closely (1)tucatinib will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

  • venlafaxine

    Serious – Use Alternative (1)venlafaxine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

  • verapamil

    Monitor Closely (1)verapamil will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Verapamil also inhibits P-gp activity, which can further increase apixaban serum levels; since both pathways of apixaban elimination are affected, patients with renal impairment receiving apixaban with drugs that are combined P-gp and moderate CYP3A4 inhibitors may increase exposure compared to patients with normal renal function; monitor for bleeding.

  • vorapaxar

    Contraindicated (1)vorapaxar increases toxicity of apixaban by anticoagulation. Contraindicated.

  • voriconazole

    Monitor Closely (1)voriconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • vortioxetine

    Monitor Closely (1)vortioxetine and apixaban both increase anticoagulation. Use Caution/Monitor.

  • voxelotor

    Serious – Use Alternative (1)voxelotor will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

  • warfarin

    Contraindicated (1)warfarin and apixaban both increase anticoagulation. Contraindicated.

  • zanubrutinib

    Monitor Closely (1)apixaban, zanubrutinib.
    Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

  • 90,000 What they are treating us with: Eliquis. To keep the blood from freezing

    One review compared oral anticoagulants to preexisting injection therapy for pulmonary thromboembolism. The new therapy turned out to be no worse and no more dangerous than the standard one, but it has its own advantages: it is more convenient to take pills than to give injections, in addition, it is easier to calculate the required dosage for these anticoagulants, and most likely it will not be necessary to adjust it either.

    A similar review looked at 11 studies with 27,945 participants with deep vein thrombosis.In this case, the scientists found that the effectiveness of both treatment options was approximately the same, but anticoagulants that suppress the work of factor Xa were less likely to cause bleeding.

    A review of the efficacy of apixaban, dabigatran, edoxaban and rivaroxaban against stroke and thromboembolism in 12,545 patients with atrial fibrillation and chronic kidney disease showed that these drugs are as effective as warfarin. In a relatively recent 2018 review, drugs targeting factor Xa are slightly better at reducing the risks of strokes and thromboembolism than drugs targeting vitamin K (the same warfarin).Next-generation drugs should also slightly reduce deaths and major hemorrhages, but here the evidence is less certain. The authors came to this conclusion after examining 13 studies with a total of 67,688 patients.

    The authors of two reviews (1 and 2) of the effect of apixaban and other anticoagulants on patients with hypertension did not find any clear evidence of the benefits or harms of such therapy: there are practically no randomized controlled trials on this topic.

    Indicator.Ru recommends: take under the supervision of a physician

    Eliquis (apixaban) is one example of an investigated drug that has successfully passed clinical trials with a good design in tens of thousands of people (although many of these trials, we will note in brackets, carried out or sponsored by the manufacturer). You may be told that it works one and a half to two times better than the great and terrible warfarin and other vitamin K inhibitors, but keep in mind that in most cases this “twice” means a difference of about 1% (and that of this it is a mere coincidence , it would also be interesting to know).However, Eliquis is definitely not worse than standard therapy, and unlike it, it can be used in a more convenient form (in tablets). It does not require frequent “calibration” of the dose, and its effect is more targeted and predictable than that of warfarin, and increases evenly with increasing dosage, and not in leaps and bounds.

    Eliquis’s list of contraindications and drug interactions is noticeably shorter than that of the old standard therapy. Contraindications include hypersensitivity; bleeding or their increased risk; liver disease leading to blood clotting problems; severe renal impairment, dialysis; childhood, pregnancy and feeding of the child (in the latter cases, there is no research confirming safety in humans).The drugs with which it is dangerous to combine Eliquis are aspirin and other drugs that increase the risk of bleeding, as well as inhibitors of CYP3A4 and P-glycoprotein, which are responsible for the breakdown of apixaban in the body.

    It is therefore not surprising that apixaban has been approved by the US Food and Drug Administration (FDA) and is included in the recommendations for physicians from the UK’s National Institute of Health and Clinical Excellence (National Institute for Health and Care Excellence). ).

    Despite this, blood clotting is always a double-edged sword. This system is very complex, and some of its mechanisms are still incomprehensible. Therefore, drugs that affect it must be taken under the constant supervision of specialists: the line between thromboembolism and bleeding can be quite thin, and both of these options can be fatal.

    Our advice cannot be equated with a doctor’s prescription. Before you start taking this or that drug, be sure to consult with a specialist.

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    cardiological drug for the prevention of heart attacks and strokes

    Trombital® – a new cardiological drug for the prevention * of the formation of blood clots – the main cause of myocardial infarction and ischemic stroke!

    Advantages of the composition of the preparation

    • Trombital ® and Trombital FORTE ® are combined preparations consisting of acetylsalicylic acid (ASA) and magnesium hydroxide
      • ASA reduces platelet aggregation, thus preventing the formation of blood clots.
      • Magnesium hydroxide helps to protect the gastrointestinal mucosa from the local irritating effect of ASA and thus improves the tolerance of ASA 2-8
    • 9 . Helps to reduce the frequency of gastrointestinal disorders by 9 times compared to the usual form of ASA 150 mg / day and 2.6 times compared to the enteric form of ASA 100 mg / day 2
    • Application ASA 75 mg / day reduces the incidence of myocardial infarction by 36% in patients with arterial hypertension 10
    • During the secondary prevention of cardiovascular diseases, the effect of ASA 75-150 mg / day was confirmed 11

    The advantage of the form of release

    • Trombital® and Trombital FORTE® – two compositions to provide an individual approach to treatment 14
    • Available 1 analogue of imported drug
    • Exhibits activity earlier than than enteric forms of ASA, as it begins to be absorbed into stomach, not in the intestine 12.13.15
    • Convenient scheme – only 1 tablet per day
    • Cover with first opening control allows you to verify the integrity of the package
    • OTC, unlike most cardiological drugs

    Indications for use

    • Primary prevention of cardiovascular diseases such as thrombosis and acute heart failure in the presence of risk factors (for example, diabetes mellitus, hyperlipidemia, arterial hypertension, obesity, smoking, old age)
    • Prevention of recurrent myocardial infarction and blood vessel thrombosis
    • Prevention of thromboembolism after vascular surgery
    • Unstable angina pectoris

    Eliquis • Price for Eliquis in Ukraine – instructions, application and dosage

    Eliquis

    Eliquis – antithrombotic drugs of the BRISTOL-MAYERS SQUIBB S.RL “, Italy. The active ingredient of the drug is apixaban.

    Apixaban is a prescription drug, anticoagulant, direct inhibitor of blood clotting factor Xa, administered orally.

    Pharmacokinetics

    When taken orally up to 10 mg of apixaban, based on the results of clinical studies, the bioavailability of the drug reaches 50%. The substance is absorbed in the digestive tract quickly, the maximum concentration is observed within 3-4 hours.

    Form of issue

    The medication on the pharmaceutical market of Ukraine is registered in tablet form.

    Readings

    The drug Eliquis is used for the following indications:

    • prophylactic treatment of venous thromboembolism after prosthetics;
    • Professional treatment for such diseases: strokes, age from 75 years, arterial hypertension, diabetes mellitus, symptomatic heart failure;
    • DVT therapy, deep vein thrombosis and pulmonary embolism, pulmonary embolism.

    Contraindications

    • Susceptibility to the composition of the drug Eliquis.
    • Bleeding of different localization and the risk of their development.
    • Liver diseases.
    • Renal dysfunction.

    The medication is not prescribed during pregnancy and lactation.

    The consequences of the use of the drug Eliquis to children (under the age of 18) have not been established.

    Contraindicated in diseases such as ulcers, tumors, head or spinal cord injuries, recent surgeries, intracranial bleeding, diagnosed or suspected varicose veins of the esophagus, arteriovenous malformations, vascular aneurysms, vascular anomalies.

    Combined use with other anticoagulants is prohibited, except for specific cases of changing anticoagulant therapy or introducing unfractionated heparin in doses necessary to ensure patency of the central venous or arterial catheter.

    Method of application

    The drug Eliquis is administered orally with water, regardless of the meal. For patients who find it difficult to swallow a tablet, you can crush and suspend it in water, glucose, or apple juice.The recommended dose of Eliquis is 2.5 mg orally 2 r. per day. The first dose should be taken 12-24 hours after surgery.

    For patients undergoing hip replacement surgery, the recommended duration of treatment is 32–38 days. For patients who have undergone surgery to replace the knee joint – 10-14 days.

    As part of the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation, the dose of Eliquis is 5 mg orally twice a day.

    Side effects

    Bleeding, contusion, epistaxis and hematoma are common adverse reactions.

    Where to buy a medication?

    You can buy

    Eliquis in the 911 network of pharmacies at an affordable price or on the official website apteka911.ua. There you can also find out about the availability of the drug and its analogues in the nearest pharmacies of the network, book, carry out self-pickup or arrange delivery, thereby protecting your health from contact with the sources of the disease.Eliquis has the lowest price in our network of pharmacies.

    The assortment of the pharmacy has a large selection of skin and hair care products.

    List of used literature

    1. Directory of Medicines Compendium.
    2. State Register of Medicines of Ukraine.
    3. References MSD.

    Popular questions about Eliquis

    What is Eliquis prescribed for?

    Eliquis is an oral selective inhibitor of blood coagulation factor Xa.It is intended for oral use in the treatment of venous thrombosis and for the prevention of thromboembolism in patients with atrial fibrillation, as well as after arthroplasty of the joints of the lower extremities.

    How much does Eliquis 60 tablets cost?

    The price for Eliquis tablets is the lowest in our network of pharmacies. You can monitor prices and compare them by entering “Eliquis price Ukraine” in the Internet search engine. Prices are constantly changing, so the currently indicated cost of a medicine for tomorrow may not be up-to-date.

    How much to take Eliquis?

    The recommended dose is 1 tab. (5 mg) 2 times a day (morning and evening, every 12 hours at the same time) by mouth, regardless of food intake, with plenty of fluids.

    What is Apixaban prescribed for?

    Antithrombotic medication is used to prevent strokes and systemic thromboembolism, to reduce mortality among patients with atrial fibrillation.

    Pay attention!

    Description of the drug Eliquis on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.Before purchasing or using the drug, you should consult your doctor and familiarize yourself with the original manufacturer’s instructions (attached to each package of the drug).

    Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide on the appointment of the drug, as well as determine the doses and methods of its use.

    90,000 14 important questions to phlebologist Evgeny Ilyukhin about thrombosis and varicose veins

    Ekaterina Kushnir

    learned everything about varicose veins and thrombosis

    Evgeny Ilyukhin

    phlebologist

    We talked with Evgeny Ilyukhin – phlebologist, candidate of medical sciences, vice-president of the Association of phlebologists of Russia.

    The doctor said what a phlebologist treats, how to prevent vein diseases, whether there are blood clots after coronavirus or vaccination and when you need to undergo an examination.

    What Do You Learn

    See your doctor

    Our articles are written with a passion for evidence-based medicine. We refer to reputable sources and go for comments from reputable doctors. But remember: the responsibility for your health lies with you and your doctor. We do not write prescriptions, we make recommendations.It is up to you to rely on our point of view or not.

    What does a phlebologist treat?

    Phlebologists deal with acute and chronic diseases of the veins, mainly on the legs. Acute diseases are superficial or deep vein thrombosis, chronic diseases are mainly superficial varicose veins.

    Varicose veins. With it, the veins expand, the blood flow in them is disrupted, and over time, venous insufficiency develops. That is, the veins can no longer fulfill their function – to return blood to the heart.

    Varicose veins – UK NHS

    Venous insufficiency – Medscape

    Normally, blood flows through the veins of the legs only upward, in particular due to the presence of valves in them. With varicose veins, the venous valves of the superficial veins can no longer restrain the blood flow downward under the influence of gravity.

    It also happens that the intradermal superficial veins expand. Then vascular “nets” or “stars” appear on the skin – this is how such changes are popularly called.

    Medical name – telangiectasias and reticular veins. This is not a disease, not a stage of real varicose veins, but just a cosmetic defect. However, many want to get rid of it. And there are techniques that allow you to do this, so the direction of aesthetic phlebology is now actively developing.

    Telangiectasia – article in DermNet Nz

    Veins of the legs are divided into deep and superficial, they are connected by perforating veins. The greater saphenous vein and the lesser saphenous vein are superficial veins, which most often become the “source” of varicose veins, and the femoral vein is an axial deep vein.With varicose veins of superficial veins there is an ejection – “leakage” of blood – from deep veins into superficial veins at their junctions or along the bridges – perforating veins. There are also valves inside the veins that prevent blood from moving downward. With varicose veins of the superficial veins, the valves are deformed and destroyed, and venous insufficiency gradually develops. Insufficiency of valves can also be in deep veins, but it is less common. Bumps of dilated superficial veins under the skin. Source: Troyan / Shutterstock Vascular mesh from superficial saphenous veins.Source: AYDO8 / Shutterstock

    Vein thrombosis develops when a blood clot forms in them, that is, a thrombus that interferes with blood flow. Most often this happens in the lower limbs. Thrombosis of superficial or deep veins in the arms also occurs, but much less frequently than in the legs. The same doctors who work with venous thrombosis of the lower extremities are engaged in the treatment of such diseases.

    Deep Vein Thrombosis – Mayo Clinic

    Deep Vein Thrombosis of the Upper Extremities – American College of Heart

    Varicose veins of the upper extremities practically do not exist as an independent disease.Secondary varicose veins of the arms can develop after thrombosis of the main veins of the limb.

    It is extremely rare that congenital anomalies are detected in the veins of the arms, for example, angiodysplasia – in simple terms, this is an abnormal development of blood vessels, their excessive expansion and growth. They are dealt with by individual doctors, not ordinary phlebologists.

    Why does varicose veins appear?

    Medicine still does not fully know why varicose veins develop. I lean towards one model that explains all scientifically proven patterns of risk factors.

    According to her, varicose veins develops in the veins in which from birth there are defects of the venous wall – congenital, but not necessarily inherited from the parents. That is, such a vein is structurally weaker than it should be. Throughout life, it expands, since it cannot effectively withstand the load.

    The more pronounced the congenital defect of the venous wall, the faster and easier varicose veins develop. Sometimes we can see him even as a teenager. And when there is no initial defect in the venous wall, the vein can withstand significant loads, so some people do not experience varicose veins, despite the risk factors.

    This theory also explains why varicose veins often appear during pregnancy. It was just that the venous wall with a defect could withstand daily loads, and the increase in loads during the period of bearing a child could no longer withstand.

    Varicose veins in Russia are found in about 10-20% of the population. Heredity plays a role in the development of the disease, but not too great. Only varicose veins have a proven effect in the closest relatives – parents.Diseases of veins in grandmothers, grandfathers and so on do not mean anything.

    Chronic venous diseases and genetic factors – international scientific journal “Phlebolymphology”

    According to one theory, varicose veins occur due to congenital weakness of the venous wall. Blood pressure gradually stretches the vein, over time the venous valves deform, therefore symptoms of venous insufficiency appear

    How can varicose veins be prevented and can it be done with lifestyle or medication?

    The main risk factors for varicose veins are gender, obesity, pregnancy, age, heredity.But since the most likely cause of the disease is a congenital defect of the venous wall, it will manifest itself without risk factors. It’s just that without them, varicose veins will develop later.

    Treatment of varicose veins – Medscape

    Today there are no working means of preventing varicose veins. Neither vein pills nor compression hosiery helps to avoid it, to stop the progression of the disease or the development of complications. The reason is that all these remedies do not eliminate the defect in the venous wall.

    Phlebotonics for venous insufficiency – Cochrane Database of Systematic Reviews

    The only purpose of venoactive drugs – they are also called venoprotective drugs, phlebotropic drugs or venotonic drugs – is symptomatic treatment. According to some reports, they relieve the symptoms that occur with varicose veins: a feeling of heaviness in the legs, swelling, fatigue of the legs, discomfort in them.

    The most interesting thing is that such manifestations may not be associated with diseases of the veins: there is no reliable data that they are caused by varicose veins.Vein medications can help, however, so they are prescribed to relieve a person’s condition. The mechanism of the development of symptoms is not important here.

    There is a large selection of drugs for veins in pharmacies, but they cannot prevent or stop the development of varicose veins. Source: Internet pharmacy “36.6”

    Do creams, dietary supplements, and leeches help with varicose veins?

    Patients often use gels, creams and ointments to relieve the symptoms of varicose veins. External products may have a different composition, but mainly two advertised groups are used:

    1. Products based on flavonoids are herbal compounds that should have a positive effect on blood vessels.They are also commonly found in vein medications – those that are taken orally. In pill form, they help relieve symptoms, but topical remedies such as ointments, gels, and creams do not work.
    2. Heparin-based drugs are an anticoagulant that prevents blood clotting. That is, the same heparin that is usually prescribed for oral administration, for example, for venous thrombosis.

    Varicose Veins: Diagnosis and Treatment – American Society of Family Physicians

    All external agents subjectively improve the condition, but it is unlikely due to the fact that they contain active compounds.The effect is most likely achieved through self-massage, foot care, cooling – these products often contain essential oils that evaporate quickly. I do not recommend using them – you can take any regular cosmetic cream, and the sensations will be the same.

    Also, for the treatment of varicose veins, you should not take dietary supplements. They sometimes contain the same flavonoids as drugs, but unlike the latter, they do not undergo rigorous safety checks.Sometimes they contain other components, usually vegetable, the effectiveness of which there is no reliable data.

    What to do? 07/02/2020

    The doctor prescribed dietary supplements along with the usual medicine. This is fine?

    In some cases, unscrupulous manufacturers add real drugs to dietary supplements, sometimes very aggressive ones.

    A huge number of dietary supplements for the treatment and prevention of venous diseases are sold on the Internet, but you should not buy or take them.Source: “Ozone”

    For the treatment of varicose veins, methods of alternative medicine are sometimes advised, in particular hirudotherapy.

    Hirudotherapy: an overview – Drugs.com

    Hirudotherapy is based on a logical idea. Leeches secrete hirudin, which is an anticoagulant that can prevent blood clots and improve blood flow.

    Most of the anticoagulants that official medicine uses for the prevention and treatment of thrombosis are substances of natural origin.Only they were cleaned, prepared and dosed, and they also checked what effect which dosage gives – because of this, taking medications is as safe as possible. But when a person is bitten by a leech, it is not clear how much anticoagulant he will receive and what the result will be.

    Therefore, I am categorically against hirudotherapy. At best, it will not help; at worst, it will harm your health. There may be bleeding, wound infection, the addition of erysipelas – this is a chronic inflammatory skin disease when the lymphatic vessels are affected.

    There is no reliable evidence that hirudotherapy is effective for the treatment of vein diseases: it does not prevent thrombosis and does not improve the condition of varicose veins.

    Leeches do not help with vein diseases. Source: kaser221 / Shutterstock

    When do you need surgery for varicose veins?

    Surgery for varicose veins should be done the sooner the better. Varicose veins always have visible objective signs, the so-called varicose veins, and they always have a source.Usually this is one vein that does not work properly, superficial or perforating, that is, connecting the deep and superficial veins of the lower extremities. The main treatment strategy for the disease is to correct this structural disorder.

    Varicose Veins – American Society of Vascular Surgery Recommendations

    Varicose Veins – MSD

    Previously, phlebologists only removed varicose veins and the source of varicose veins, performing operations with incisions, which sometimes required significant restrictions.In modern phlebology, with small varicose veins, sclerotherapy is often used – the sealing of a vein with the help of special preparations introduced into it.

    In most cases, the basis of treatment today will be radiofrequency or laser ablation: when a radiation source is introduced into a vein, its walls seem to stick together, blood no longer passes through the vessel. Then the diseased vein gradually dissolves without a trace.

    Without surgery, varicose veins will progress further – in different people at different rates.If you postpone treatment for a long time, the amount of intervention will be greater, so it is better to remove varicose veins at an early stage. In addition, the further, the higher the risk of complications, in particular thrombophlebitis – inflammation of the affected vein and the formation of blood clots in it.

    During radiofrequency or laser ablation, the walls of the diseased vein seem to stick together, blood can no longer flow through it “in the wrong” direction, but it did not flow to the correct one due to the destruction of the valves

    Why does venous thrombosis occur and how to prevent it?

    For a particular person, the risk of venous thrombosis is assessed taking into account age, health status and other factors.For some situations, the risk of thrombosis is calculated using special scales. For example, the Caprini scale is used before elective surgery. If this risk is increased, prevention of blood clots is needed.

    Prevention of venous thrombosis is prescribed as follows: before a potentially dangerous event, for example, when planning an operation, a person goes to a doctor, who assesses the risks and tells what to do.

    Prevention of thromboembolic symptoms – National standard of the Russian Federation

    For prophylaxis one person will have enough compression hosiery and early activity after the operation – to start getting up on the first day, while another will need special medications.

    Also, the risk of blood clots is assessed before the appointment of combined oral contraceptives. They increase the likelihood of venous thrombosis – not much, but they are not prescribed for people at risk.

    The danger of vein thrombosis is that a blood clot can come off and cause such a formidable complication as PE – pulmonary embolism, that is, its blockage by a thrombus

    Popularly popular aspirin prevents arterial thrombosis, that is, heart attack and stroke, but it does not work well against venous thrombosis, therefore it is not recommended in phlebological practice.

    All anticoagulants have serious side effects, aspirin is also an unsafe medicine, so only a doctor should prescribe them, taking into account all the risks.

    Is there a genetic predisposition to venous thrombosis?

    After the discovery of hereditary thrombophilia, doctors began to frequently prescribe genetic tests. It seemed that the found genetic features can explain and predict the occurrence of venous thrombosis.

    Then it became clear that the role of thrombophilia was greatly overestimated.They do not always give such a high risk to prescribe prevention of blood clots, and they themselves are rare.

    In most cases, you should not be afraid of hereditary thrombophilia.

    Genetic testing is recommended when planning pregnancy. But if a woman has previously had venous thrombosis or has close relatives with venous thrombosis, then doctors will have to classify her as a high-risk group without any tests and take maximum preventive measures.

    If the risk of thrombosis is high, your doctor may prescribe prophylactic anticoagulants throughout pregnancy and after childbirth.

    Also, such screening may be advisable when deciding whether to take COCs. However, if a woman has had venous thrombosis in the past, such contraception is not suitable for her in any case, an examination is not needed.

    One of the problems of screening for thrombophilia in Russia is that thrombophilia is often referred to as variants of genes that do not at all increase the risk of thrombosis.It is more correct to investigate not all hemostasis genes, but only those that are really associated with an increased risk of thrombosis.

    There are only two genetic thrombophilia – this is the coagulation factor V polymorphism, the so-called Leiden mutation, and the factor II polymorphism – prothrombin. Other congenital and acquired thrombophilia are diagnosed with non-genetic tests.

    Does varicose veins increase the risk of venous thrombosis?

    Veins are divided into superficial and deep, blood clots can form in both.Varicose veins of superficial veins often lead to their thrombosis, as there is damage to the vessel wall and impaired blood flow, slowing it down. In this case, thrombosis of superficial veins can lead to the appearance of blood clots in the deep veins, since they are connected with each other.

    Superficial vein thrombosis – Uptodate

    Superficial vein thrombophlebitis – Medscape

    Together with blood clots in a vein, an inflammatory process is always observed – phlebitis. In superficial veins, unlike deep ones, it is clearly visible, therefore this condition is called thrombophlebitis.

    It cannot be said that a person with varicose veins will have thrombophlebitis in 100% of cases and blood clots form in the superficial veins, it’s just more likely. This risk is completely manageable – you can get rid of varicose veins and immediately reduce it.

    Deep vein thrombosis is more dangerous because it often leads to pulmonary embolism, or pulmonary embolism. This is a serious complication that occurs when a blood clot breaks off and enters the bloodstream. With thrombosis of superficial veins, PE is also possible, but it is less common and only with damage to large venous vessels, for example, the large or small saphenous vein.

    Can a coronavirus vaccine trigger thrombosis?

    In a mild form of coronavirus infection, when a person is treated at home, the frequency of venous thrombosis does not increase much.

    COVID-19 provokes deadly thrombosis – The Lancet magazine

    Prevention of complications, dispensary observation and outpatient management of persons who have had a new coronavirus infection COVID-19. Interim Clinical Guidelines PDF, 740 KB

    Vein thrombosis often occurs in severe forms of coronavirus when a person is treated in a hospital.This can be explained not only by the effects of infection, but also by the very fact of hospitalization and long-term inactivity.

    The likelihood of blood clots depends on the severity of the disease and the condition of the person. People with risk factors such as vein thrombosis in the past or older age have higher risk factors.

    If a person falls ill with COVID-19 and is admitted to the hospital, he is prescribed anticoagulant therapy to prevent venous thrombosis. In people at risk, it can be continued after discharge.

    Those who were treated at home do not need such prophylaxis – they should not be afraid of vein thrombosis and drink anticoagulants during or after an illness. You need to know that taking anticoagulants can lead to complications, such as bleeding, so they are not used without serious reasons.

    Heparin and low molecular weight heparin: dosage and side effects – Uptodate

    Venous thrombosis after coronavirus vaccination is caused by immune thrombotic thrombocytopenia associated with the COVID-19 vaccine.Similar thrombocytopenias rarely occur while taking other medications – for example, the same anticoagulants for the treatment of thrombosis.

    A well-known example is heparin-induced thrombocytopenia, which increases the risk of venous and arterial thrombosis. It rarely develops while taking heparin.

    Such thrombosis is an individual reaction of the immune system. The body reacts paradoxically to the drug – it produces antibodies against its own platelets. In this case, not only the number of platelets decreases, but their activation also occurs, as a result of which blood clots are formed.

    The risk of venous thrombosis after a severe form of coronavirus infection is an order of magnitude higher than after vaccination: it occurs in about 20% of seriously ill patients. By protecting people from a severe course of infection with a vaccine, we greatly reduce the risk of developing such complications.

    Prophylaxis of venous thrombosis is not needed before vaccination against coronavirus – even for people at increased risk. The likelihood of blood clots is too low, it is less than the likelihood of side effects from taking anticoagulants.

    How to define venous thrombosis and are there any screening tests?

    A clear sign of venous thrombosis is edema of only one limb. Not local swelling, but swelling of the entire leg or, less often, of the arms. Sometimes this also happens with lymphatic edema, which occurs due to a violation of the outflow of lymph. However, when the swelling has developed rapidly, the first thing to think about is venous thrombosis. Such a symptom is a reason to urgently consult a doctor, you can even call an ambulance, you cannot postpone it for a day.

    Deep Vein Thrombosis – UK NHS

    There are no screenings that can detect venous thrombosis in advance. Blood coagulates on average in 5-10 minutes. During this time, a thrombus is formed, so there is no point in screening – now nothing has been found, but after 10 minutes thrombosis may occur.

    This is what edema of one limb looks like in deep vein thrombosis. Source: NHS

    Are there ways to prevent thrombosis and varicose veins for pregnant women?

    There are no special measures for the prevention of venous thrombosis for pregnant women.The approach is the same as in other cases: the doctor assesses the individual risk and decides whether to prescribe anticoagulants or not.

    Russian clinical guidelines for the diagnosis and treatment of chronic venous diseases PDF, 1.15 MB

    For pregnant women with low risk, only nonspecific measures for the prevention of venous thrombosis are suitable – this is mobility. When the muscles work, the blood in the veins does not stagnate, and the risk of blood clots is lower.

    There can be several scenarios for varicose veins:

    1. a woman is planning a pregnancy, she does not have varicose veins – nothing needs to be done here, because there is no prevention of this disease;
    2. a woman has varicose veins before pregnancy – it must be removed at the planning stage;
    3. varicose veins appeared during pregnancy or it was not removed before her – you need compression hosiery.It will not help to avoid complications, but it will relieve symptoms and, possibly, slightly inhibit further expansion of the veins.

    I do not prescribe phlebotonic drugs to pregnant women. Several studies of their safety were carried out, they did not find any negative consequences of admission, but according to these data, one hundred percent safety cannot be guaranteed. The benefits of such drugs are not so great – they only relieve symptoms, so I don’t think they should be taken during pregnancy.

    For the treatment of varicose veins in pregnant women, you can do with compression hosiery, which certainly does not hurt.Knee-highs with a slight degree of compression can be recommended even for pregnant women without varicose veins – such knee-highs will help relieve discomfort in the legs and reduce swelling.

    It is not necessary to wear compression stockings during childbirth: they are required during operations such as caesarean section, but not during natural active childbirth.

    Does compression garments help with varicose veins?

    Compression hosiery is a symptomatic remedy that helps to remove unpleasant sensations in the legs and prevents swelling.For this, it can be advised even to healthy people. For example, those whose legs are swollen from standing for a long time or during long flights.

    Recommendations for the diagnosis and treatment of varicose veins – UK National Clinical Guidelines

    At the same time, compression hosiery does not protect well against deep vein thrombosis or thrombophlebitis with varicose veins. True, there is evidence that it reduces the risk of asymptomatic, that is, not severe, thrombosis during long flights – longer than four hours.However, with a high risk of severe thrombosis, special drugs that thin the blood – anticoagulants in tablets or injections – are more effective as a prevention.

    Compression hosiery is often called anti varicose, although it cannot prevent disease. However, it helps relieve unpleasant symptoms. The doctor advises the required degree of compression and the type of jersey, to healthy people, for the prevention of edema, rather simple compression golfs. Source: Ozone

    Does swelling in the legs always indicate problems with the veins?

    Edema of the lower extremities can have many causes: heart failure, kidney disease, cirrhosis of the liver and many other conditions.Bilateral swelling in the legs is often unrelated to venous disease.

    Causes of edema of the lower extremities – Mayo Clinic

    Phlebologists often see such situations: a person has serious varicose veins, huge varicose veins, but there is no edema and nothing worries. Edema in diseases of the veins often occurs already in chronic venous insufficiency, when the superficial and deep veins completely cease to cope with the drainage of blood from the lower extremities.

    For those who are concerned about leg swelling, the following universal advice can be given:

    1. edema of one leg – a reason to suspect venous thrombosis, you need to call an ambulance;
    2. edema of both legs is a reason to contact a therapist to schedule an examination and, if necessary, refer to a specialized specialist.

    Varicose veins over time can lead to the development of venous insufficiency: it is manifested by edema and discoloration of the skin. Later, due to circulatory disorders, trophic ulcers may appear – non-healing skin lesions

    When should you go to a phlebologist and should you do it for prevention?

    It is worth contacting a doctor when you have questions or complaints. There are no hidden vein diseases, so preventive examinations or screenings are not needed to detect them.The patient will notice varicose veins or severe edema himself faster than the doctor – then he needs to seek help.

    I have a negative attitude to unnecessary visits to phlebologists and examinations. It so happens that an ultrasound of the vessels is prescribed, some individual features of the structure of the veins are seen, and as a result, unnecessary treatment is prescribed. Sometimes they even do an operation, although the person feels great and has no problems.

    Remember

    1. Phlebologists deal with acute and chronic diseases of the veins, mainly in the legs.
    2. Varicose veins develop in the vein where there are defects in the venous wall from birth – not hereditary, but congenital. The stronger the defect, the faster the varicose veins will appear.
    3. The main risk factors for varicose veins are obesity, pregnancy, heredity. Also, the likelihood of developing varicose veins increases with age.
    4. External agents for the treatment of varicose veins cause a subjective improvement in the condition, but probably not due to the fact that they contain active compounds.The effect is achieved through self-massage, foot care, cooling. But dietary supplements and hirudotherapy are not the best choice, such treatment will not be beneficial.
    5. Surgery for varicose veins should be done the sooner the better. To remove any varicose veins, minimally invasive methods are used; in modern phlebology, the treatment of any varicose veins can be carried out on an outpatient basis and in most cases under local anesthesia. Such treatment is no more cumbersome than a visit to the dentist.
    6. For the prevention of venous thrombosis, the individual risk is calculated, after which the doctor can prescribe special medications.
    7. The genetic risk of venous thrombosis is not so common, and in most cases it is not necessary to undergo any examination.
    8. With varicose veins, blood clots are more likely to form in the superficial and deep veins.
    9. Vein thrombosis often occurs in severe forms of coronavirus infection. In milder forms of the disease and after vaccination against it, this happens extremely rarely, no special prophylaxis is needed.
    10. There are no separate measures for the prevention of venous thrombosis for pregnant women, the approach is the same as in other cases. For varicose veins, compression hosiery is recommended.
    11. Compression hosiery is a symptomatic remedy that helps to remove unpleasant sensations in the legs, prevents swelling. For this, it can be advised even to healthy people.
    12. Edema of the lower extremities can have many reasons: heart failure, kidney disease, liver cirrhosis, and others.