Apixaban (Eliquis): What You Need to Know

Apixaban, sold as Eliquis, is a modern oral blood thinner many doctors use to prevent strokes in atrial fibrillation and to treat or prevent blood clots (DVT/PE). It works by blocking factor Xa, which lowers the blood’s ability to form clots. Compared with warfarin, large trials like ARISTOTLE showed apixaban cuts stroke risk and causes less major bleeding for many patients. That makes it a common choice, but it still needs careful handling.

Who takes apixaban and typical doses

Common uses: preventing stroke in non-valvular atrial fibrillation, treating DVT/PE, preventing recurrent clots, and after some hip/knee surgeries to prevent clots. Typical adult dosing is:

• Atrial fibrillation: 5 mg twice daily. Reduce to 2.5 mg twice daily if you meet two of: age >80, weight <60 kg, or creatinine >1.5 mg/dL.
• Acute DVT/PE: 10 mg twice daily for the first 7 days, then 5 mg twice daily.
• Post-op prevention (hip/knee): 2.5 mg twice daily for the approved period.

How to take it and stay safe

Take apixaban exactly as prescribed, usually twice a day. You can take it with or without food. If you miss a dose, take it as soon as you remember the same day; don’t double up the next dose. Before any surgery or a dental extraction, tell the surgeon or dentist you take apixaban. They will advise when to stop it—often 24–48 hours before a procedure for low-risk bleeding, longer for high-risk procedures or poor kidney function.

Watch for interactions: strong CYP3A4 and P-gp inhibitors (like ketoconazole, ritonavir) can raise apixaban levels and increase bleeding risk. Strong inducers (like rifampin, carbamazepine) can lower effectiveness. Also avoid combining it with other strong blood thinners or frequent NSAID use. Alcohol and drugs that affect platelets (SSRIs, SNRIs) raise bleeding risk too.

There’s no routine INR monitoring like with warfarin. Instead, your provider will check kidney function before starting and periodically after. If you need urgent reversal for life-threatening bleeding, andexanet alfa is the specific antidote; when that’s not available, prothrombin complex concentrate (PCC) may be used.

Common side effects are bleeding (nosebleeds, bruises, heavy periods) and rarely serious bleeding inside the body. Seek immediate care for black tarry stools, coughing up blood, sudden severe headache, weakness, or fainting. If you’re pregnant or have mechanical heart valves, apixaban is usually not the right choice—talk to your clinician.

If you have questions about switching from warfarin, starting after a clot, or how long to stay on apixaban, ask your healthcare team. They’ll weigh your clotting risk versus bleeding risk to find the safest plan for you.