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Back to Apixaban. Apixaban is a type of medicine known as an anticoagulant. It makes your blood clot more slowly. Blood clotting thickening is a complicated process involving substances called clotting factors. Clotting factors are made by the liver and help stop bleeding. They work with blood cells called platelets that trigger the clotting process to make sure your blood clots properly. Apixaban works by stopping a clotting factor called factor Xa working. This makes it take longer for your blood to clot. There do not seem to be any lasting harmful effects from taking it for many months or even years. If you stop taking apixaban, the rate at which your blood clots will return to what it was before you started taking it, usually within a day or two of stopping. This means that you may be at increased risk of serious problems like stroke , heart attack , deep vein thrombosis or pulmonary embolism. There are several other anticoagulants available as tablets or capsules. There are also anticoagulants that you take by injecting them. These include:. Talk to your doctor or pharmacist to find out why you have been recommended a particular medicine. If you have an accident, it's important that the person treating you knows you are taking an anticoagulant. Because of the risk of bleeding, your dose of apixaban may need to be lowered or stopped a few days before you have an operation. Tell the surgeon that you're taking apixaban and show them your anticoagulant alert card. Also tell anyone else involved with your care, such as your anticoagulant specialist, so they can arrange any changes to your medicine for you. But tell your dentist that you're taking apixaban, and show them your anticoagulant alert card, before you have any treatment. Most people do not need to change their apixaban dose, but your dentist may contact your doctor for advice before starting the dental treatment. Having a body piercing or tattoo is not recommended while you're taking apixaban. If you still want to go ahead, talk to your doctor about your specific risks in case you need antibiotics. And let the tattooist or piercer know beforehand that you're taking an anticoagulant medicine. But if you have any concerns about your hair while taking this medicine or you notice any changes, speak to your doctor or pharmacist. You can have vaccinations while taking apixaban. Before you have them, be sure to show your anticoagulant alert card to the nurse or doctor. It's important to tell them that you're taking apixaban, in case there's any bleeding at the site of the injection. It might help prevent bruising if you press on the injection site for 10 minutes after the vaccination. You can continue to take part in non-contact sports, such as running, athletics, cycling, tennis and badminton. But be sure to use the right protective clothing or equipment, like wearing a helmet when riding your bike. This is because these types of sports can lead to an injury, which would further increase the risk of bleeding. Apixaban does not affect any type of contraception, including the combined pill and emergency contraception. Most people can drive or ride a bike while taking apixaban. But if taking apixaban makes you feel dizzy or light-headed, do not drive or cycle until this feeling goes away. It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive. Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking apixaban. UK has more information on the law on drugs and driving. You can drink alcohol while taking apixaban as long as you do not drink more than 14 alcohol units a week. A standard glass of wine ml is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol. Drinking heavily, especially binge drinking lots of alcohol in one go, is dangerous while taking apixaban. The alcohol can increase the risk of bleeding. Apart from being careful with alcohol, there are no foods or drinks you need to avoid while taking apixaban. It's not clear how other recreational drugs like cocaine and heroin affect apixaban. They could be potentially dangerous. Talk to your doctor if you think you might use recreational drugs while taking apixaban. Find out more about the side effects of some recreational drugs on the Frank website. You can reduce your risk of having a blood clot by making changes to your lifestyle, such as:. Page last reviewed: 14 May Next review due: 14 May Common questions about apixaban. How does apixaban work? Apixaban works within a few hours of taking it. Apixaban is safe to take for a long time. Do not stop taking apixaban without talking to your doctor. They include: rivaroxaban dabigatran edoxaban warfarin There are also anticoagulants that you take by injecting them. These include: heparin enoxaparin dalteparin tinzaparin Not all medicines that prevent blood clots are suitable for everyone. You will need to carry an anticoagulant alert card with you at all times. You can still go to your dentist as usual. This is especially important if you need to have a tooth out. This is because of the increased risk of bleeding and infection. Some people report hair loss when taking certain anticoagulants. Apixaban does not seem to affect the hair or cause hair loss. Avoid all contact sports, particularly martial arts and kickboxing. It's thought that cannabis can increase your risk of serious bleeding. Injecting while taking apixaban will increase your risk of bleeding. You can reduce your risk of having a blood clot by making changes to your lifestyle, such as: quitting smoking eating a healthy, balanced diet getting regular exercise keeping to a healthy weight or losing weight if you need to.

Common questions about apixaban

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ABSTRACT: Drug-induced bleeding presents in many ways, including excessive bruising, nosebleeds, heavy menses, gastrointestinal bleeding, and rectal bleeding. Drug-induced bleeding is potentiated by numerous drugs, natural medicines, and drug-drug interactions. Pharmacists should be aware of patient-specific risk factors and should actively monitor for medications that contribute to bleeding. By minimizing the risk of drug-induced bleeding in patients, pharmacists have the opportunity to reduce long-term adverse effects. In addition, pharmacists can educate patients on ways to reduce the risk of drug-induced bleeding and help them recognize the symptoms of drug-induced bleeding. Drug-induced bleeding is commonly thought of as gastrointestinal GI bleeding resulting from the use of nonsteroidal anti-inflammatory drugs NSAIDs. Nosebleeds and abnormal bruising, in addition to GI bleeding, may be linked to the use of oral anticoagulants. Hemorrhoidal bleeding may be associated with drugs that cause constipation. In addition, other predictors that may contribute to or cause an increase in bleeding include advancing age, the use of multiple drugs, drug-drug interactions, and coexisting diseases or conditions. This article will focus on drug-induced bleeding that is caused primarily by agents other than NSAIDs. Selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors are reported to inhibit the reuptake of serotonin into platelets, resulting in an increased risk of bleeding. Fluoxetine and fluvoxamine pose additional risks since they inhibit warfarin metabolism by CYP enzymes. Anticoagulants are used for the prevention and treatment of deep venous thrombosis, pulmonary embolism, and thromboembolism and for the prevention of stroke in atrial fibrillation. NOAs are direct inhibitors of factor Xa rivaroxaban, apixaban, edoxaban and thrombin factor IIa, dabigatran. Bleeding associated with their use is treated with the administration of RBCs and plasma, activated prothrombin complex concentrate, or recombinant factor VIIa, hemodialysis, or idarucizumab for dabigatran. This symptom may be perplexing to patients who cannot differentiate between dyspepsia and abdominal pain associated with bleeding. Untreated constipation can lead to complications, including hemorrhoids, anal fissures with rectal bleeding, and rectal prolapse. Certain natural medicines and supplements have been reported to cause bleeding either on their own or when used in combination with other drugs. TABLE 3 lists common natural medicines that affect platelet aggregation and could elicit bleeding. Medication reconciliation and patient education prevent moderate or significant drug-drug interactions. It is recommended to check the international normalized ratio INR 5 days after initiation of an antimicrobial or antibiotic in patients taking warfarin. Risk factors for increased bleeding include use of a drug or natural medicine that has the potential for bleeding TABLES ; concomitant use of drugs causing drug-drug interactions TABLE 4 ; advancing age; prior history of GI bleeding; decreased renal function; uncontrolled hypertension; regular or excessive use of alcohol; and the presence of Helicobacter pylori. Prescribing information and FDA Medication Guides instruct patients to immediately contact their healthcare provider if symptoms of bleeding are present. Signs and symptoms of minor bleeding include gum bleeding, occasional nosebleeds, easy bruising, or bleeding that takes longer than normal to stop. Education on reducing the risk of bleeding includes the recommendation to avoid all drugs that interact with anticoagulants and other drugs known to potentiate bleeding TABLES 1 and 2. If analgesia is needed, acetaminophen at a maximum dosage of 2 g per day may be used. Patients should be counseled not to double up on doses in the event of missing a dose and not to skip doses in an effort to save money. Patients should be encouraged to document their compliance with an electronic device or on a calendar. A current medication card should be maintained at all times so that all healthcare providers are aware of all medications. In some cases, a sudden or severe episode of headache, dizziness, faintness, or weakness will occur before the medical emergency. Other emergency symptoms that are linked to bleeding or stroke include unusual pain or swelling and abnormalities in vision, speech, or gait. Dietary guidelines to maintain a consistent diet are important for patients taking warfarin. Sudden changes in diet to include high or extra intake of green, leafy vegetables or other foods high in vitamin K will cause the blood to clot, resulting in a lower INR and an increased risk of bleeding. Finally, patients who are taking drugs that could potentiate bleeding because of constipation should be advised to increase fruit and vegetable intake, increase fluid intake, make sure that at least one-half of all grains they consume are whole grains, and consume 25 g to 38 g of fiber daily. In addition to patient education on the signs of bleeding and how to minimize bleeding risk, pharmacists play an important role in helping reduce the risk of drug-induced bleeding by monitoring patient medication profiles for potential drug-drug interactions and by conducting patient interviews to identify other items that may increase risk, such as advanced age, alcohol consumption, use of natural medicines, past medical history, and family history. Bleeding as a result of medication therapy is a severe complication that has a negative impact on patient safety. In many cases, bleeding is not easily identified as a drug-induced problem. Pharmacists can play a pivotal role in minimizing the development of drug-induced bleeding by being aware of the contributing risk factors and medications. Coumadin warfarin product information. Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis. Am J Gastroenterol. Use of nonsteroidal anti-inflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Bleeding incidence with concomitant use of antidepressants and warfarin. Ther Drug Monit. Inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding in elderly patients: retrospective cohort study. Gastrointestinal bleeding with the new oral anticoagulants—defining the issues and the management strategies. Thromb Haemost. Novel oral anticoagulants in gastroenterology practice. Gastrointest Endosc. Bleeding risk with dabigatran in the frail elderly. N Engl J Med. Risk of gastrointestinal bleeding associated with oral anticoagulants: population based retrospective cohort study. Pradaxa dabigatran product information. Accessed June 27, Natural Medicines Comprehensive Database. Accessed June 14, Warfarin with fluoroquinolones, sulfonamides, or azole antifungals: interactions and the risk of hospitalization for gastrointestinal bleeding. Clin Pharmacol Ther. Clopidogrel and proton pump inhibitors—where do we stand in ? World J Gastroenterol. Plavix clopidogrel product information. Celexa citalopram product information. Heparin sodium injection product monograph. Ketorolac tromethamine product information. Feldene piroxicam product information. Xarelto rivaroxaban product information. Effexor XR venlafaxine product information. In: Cohen H, ed. Casebook in Clinical Pharmacokinetics and Drug Dosing. Peptic ulcer disease. Pharmacotherapy: A Pathophysiologic Approach. American Heart Association. Effect of acetaminophen on international normalized ratio in patients receiving warfarin therapy. Featured Issue Featured Supplements. US Pharm. Patient Education Prescribing information and FDA Medication Guides instruct patients to immediately contact their healthcare provider if symptoms of bleeding are present. Conclusion Bleeding as a result of medication therapy is a severe complication that has a negative impact on patient safety. To comment on this article, contact rdavidson uspharmacist. Related CE. View More CE. Related Content. All rights reserved. Reproduction in whole or in part without permission is prohibited.

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