What Are The Side Effects Of Eliquis In The Elderly?

Blood thinning medications, or anti-coagulants, are commonly prescribed to older individuals. 

Blood thinners can help reduce the risk of serious health problems like heart attacks and strokes, but they also come with significant risks and side effects.

Elderly people are especially at risk of developing potentially serious health problems from blood clots, so many are prescribed blood thinners such as Eliquis.

But what are the side effects of Eliquis (Apixaban) in the elderly? Keep reading to find out.

What is Eliquis (Apixaban)?

Eliquis is the brand name for apixaban, a prescription blood thinner. Blood thinning medications are also called anticoagulants. Eliquis works by blocking an enzyme complex called Xa, which helps blood clots to form. 

It’s important to prevent blood clots since they can travel to your brain or heart and cause a blockage in blood flow, resulting in a stroke or heart attack, respectively. 

The Food and Drug Administration (FDA) first approved Eliquis in 2012 to help reduce the risk of stroke and blood clots in patients with nonvalvular atrial fibrillation (an abnormal heart rhythm not caused by an abnormal heart valve). 

The FDA approved Eliquis again in March 2014 to help reduce blood clots following hip and knee replacement surgeries. In September 2014, they approved it to help treat deep vein thrombosis (DVT) and pulmonary embolism (PE), which occur from blood clots getting stuck in the veins of the leg or the lungs.

Eliquis comes in 2.5 milligram- and 5-milligram tablets. Eliquis can be taken with or without food and is taken twice daily. The maximum daily dosage of Eliquis is typically 10 milligrams twice daily.

Why are blood thinners prescribed to seniors?

Compared to younger patients with atrial fibrillation, older people with Afib are more likely to suffer from a stroke (1). Atrial fibrillation is more common in older people, largely due to the aging of the heart muscles (2).

It’s recommended that all patients 75 years and older who have atrial fibrillation take a blood thinner (3).

Even without atrial fibrillation, seniors are at a greater risk of developing blood clots (4). Blood thinners increase the risk of bleeding, so they should only be prescribed if their potential benefits outweigh the risks. 

What are the side effects of Eliquis in the elderly?

Eliquis has potential side effects and warnings, which can occur regardless of your age. The most common side effects of Eliquis in the elderly include:

• Bleeding from cuts that take longer to stop
• Bleeding from your nose or gums
• Dizziness
• Bruising easily
• Minor bleeding
• Nausea

Most of the time, bleeding from Eliquis is considered minor. In rare cases, it can be serious and may lead to death from blood loss. 

Your risk of bleeding is higher if you’re also taking other anticoagulant drugs like warfarin, heparin, aspirin, and non-steroidal anti-inflammatories (NSAIDs) like naproxen (Aleve) and ibuprofen (Advil). SSRIs used to treat depression may also increase the risk of bleeding while taking Eliquis.

Eliquis is not to be used if you have an artificial heart valve, have certain clotting disorders or abnormal bleeding, or are allergic to its active ingredients. 

Eliquis also isn’t recommended if you have antiphospholipid syndrome, a condition when your body mistakenly attacks tissue in your body and can lead to blood clots.

If you can’t take Eliquis due to side effects or certain health conditions, talk to your doctor about alternative medications to Eliquis you could take instead.

Are the side effects of Eliquis different in the elderly compared to younger patients?

The side effects of Eliquis are similar for elderly people and younger patients. Elderly people who unintentionally misuse their medications (accidentally taking too much or too little, for instance) are more likely to have severe side effects like increased bleeding or new blood clots.

Elderly people might also be more prone to experiencing side effects like nausea if they aren’t eating much, which can be common among older patients due to reduced appetite.

How to reduce side effects

If you have gastrointestinal symptoms like nausea from taking Eliquis, taking it with food or milk can help reduce the side effects.

The most effective way to reduce side effects like excessive bleeding is to take Eliquis as prescribed. Taking too much or too little Eliquis can result in abnormal bleeding or blood clots, which can be serious and even fatal.

A pill organizer can be helpful if you have difficulty remembering to take medications regularly. You can choose a pill organizer with AM and PM designations so you never forget if you took your dose, which can prevent accidental extra doses.

If you have surgery planned, your healthcare provider can guide you on how to adjust Eliquis before and after surgery to minimize complications like excessive bleeding. You’re also more likely to develop a clot after surgery, so taking Eliquis as instructed before and after surgery is essential.

What to avoid while taking Eliquis 

To maximize its effectiveness, you might want to consider the foods to eat and foods to avoid while taking Eliquis. Some of the most important things to avoid while taking Eliquis include:

Drinking alcohol

Alcohol can act as a blood thinner and increase the risk of bleeding. You should avoid drinking large amounts while taking Eliquis to reduce this risk since severe bleeding can cause anemia and can even be fatal in some cases.

Taking other blood thinners with Eliquis

Taking other types of blood thinners along with Eliquis can increase your risk of severe bleeding. Some examples of common blood thinners include Coumadin (warfarin), Lovenox, Pradaxa, and Xarelto.

If you need to switch to another type of blood thinner after taking Eliquis, your healthcare provider might suggest tapering off the Eliquis as you gradually increase the dose of the new blood thinner.

Using sharp objects

You’re more likely to bleed longer while on Eliquis because your blood won’t clot as fast, so you should take extra caution not to cut yourself while taking Eliquis. 

If you accidentally cut yourself, whether you’re chopping food in the kitchen or cutting wood outside, it could become much more serious while on Eliquis. If possible, try to designate those responsibilities to other people or wear a protective covering to minimize the risk of a deep cut.

Is Eliquis a high-risk medication?

Eliquis is considered a “high alert” medication, which means that while it can be safe and effective, it can also come with risks like severe bleeding or a stroke. 

Severe bleeding and stroke are more likely to occur if you don’t take Eliquis as prescribed, such as taking too much or skipping doses.

The risk of complications from taking Eliquis is greater in older people who have experienced memory loss or who can become confused at times. 

If that’s the case, someone should be available to assist them in following their dosing schedule, such as a home health aide, family member, or staff member of an assisted living facility.

What is the safest blood thinner for the elderly?

Compared to other blood thinners like Coumadin (warfarin), Eliquis has fewer interactions, making it a safer option for some patients. Coumadin interacts with vitamin K, which is found in many foods, especially dark green vegetables. 

Patients on warfarin are instructed to keep their intake of vitamin K consistent since large changes in vitamin K intake can affect the thickness of the blood and can increase the risk of bleeding and blood clots.

Another advantage of Eliquis is that it doesn’t require routine blood tests to measure clotting time and blood thickness like Coumadin does.

Newer anticoagulant drugs, including Eliquis, are considered just as effective and are safer to use among elderly patients (3). 

What happens when you stop taking Eliquis? 

Eliquis has a black box warning, which is the highest level of caution the FDA gives. The warning is an increased risk of blood clots if you suddenly stop taking Eliquis, which is the most serious side effect of stopping Eliquis.

Stopping Eliquis should be carefully done under the guidance of a qualified health professional. When stopping Eliquis, watch out for symptoms of a blood clot which can include:

• Throbbing or cramping pain, swelling, redness, and warmth in your arm or leg
• Sudden difficulty breathing
• Sharp chest pain (may be worse when you breathe in)
• Cough or coughing up blood

Because your risk of heart attack and stroke might be higher when stopping Eliquis, it’s also a good idea to be aware of the symptoms of a heart attack and stroke.

Heart attack symptoms

• Chest pain or discomfort, which might feel like pressure, squeezing, fullness, or pain
• Feeling weak, light-headed, or faint; breaking into a cold sweat is also a symptom
• Pain or discomfort in your jaw, neck, or back
• Pain or discomfort in one or both arms/shoulders
• Shortness of breath, which usually accompanies other symptoms

Stroke symptoms

• Sudden numbness or weakness in your face, arm, or leg, especially on one side of your body
• Sudden confusion, trouble speaking, or difficulty understanding speech
• Suddenly having trouble seeing out of one or both eyes
• Sudden trouble walking, dizziness, loss of balance, or lack of coordination
• Sudden severe headache with no known cause

Natural blood thinners

If you’ve been prescribed a blood thinner, it’s important not to stop taking it in favor of natural blood thinners since this could result in serious complications. 

If you’re taking a prescription blood thinner, it’s good to be aware of foods with natural anticoagulant properties. 

While there aren’t any known food-drug interactions with Eliquis, you might be at greater risk of severe bleeding if you eat large amounts of natural blood thinners while taking Eliquis.

Vitamin E

According to a study, vitamin E might significantly lower your risk of blood clots, especially if you’ve had a blood clot before.

Taking too much vitamin E can cause excessive bleeding, so you should consult your healthcare provider before taking any vitamin E supplements while on prescription blood thinners. 

The risk of bleeding from vitamin E toxicity is more prevalent with doses above 1,000 milligrams per day. For reference, most vitamin E supplements provide 400 IU of vitamin E, equivalent to 180 milligrams.

Some foods naturally rich in vitamin E include:

• Wheat germ oil
• Sunflower, safflower, and soybean oil
• Sunflower seeds
• Almonds
• Peanuts, peanut butter
• Beet greens, collard greens, spinach
• Pumpkin
• Red bell pepper
• Asparagus
• Mango
• Avocado

Foods high in salicylates

Salicylates are compounds found in some plant foods and are also found in aspirin. Aspirin is often used to help reduce heart attack and stroke risk in patients who don’t require a prescription blood thinner.

Salicylates can block the action of vitamin K, which promotes blood clotting by producing certain clotting factors (5). 

Some foods and drinks particularly high in salicylates include:

• Vegetables like broccoli, cauliflower, cucumber, mushrooms, radishes, spinach, and zucchini 
• Tomatoes
• Fruit juice (apple, grape, orange, and grapefruit juices)
• Fruits like apples, avocados, berries, cherries, grapes, peaches, and plums
• Spices like thyme, rosemary, curry powder, paprika, and garam masala
• Black, green, and herbal teas

Ginger

There are some studies on ginger’s potential to slow the coagulation process. A review looked at ten scientific studies about ginger and platelet aggregation, which is when blood cells stick together to form clots (6).

Out of the ten studies in the review, four clinical trials found that ginger decreased platelet aggregation, meaning it slowed blood clotting and acted as a blood thinner. The rest of the studies didn’t find a correlation between ginger and blood clotting factors.

Conclusion

Blood thinners are commonly recommended for elderly patients with atrial fibrillation to help reduce the risk of stroke and heart attack. Eliquis is the brand name for apixaban, a prescription anticoagulant (blood thinning) medication.

Eliquis is among some of the safer options for elderly patients because it doesn’t have any nutrient interactions, nor does it require routine lab monitoring.

The most common side effects of Eliquis are increased bleeding, dizziness, and nausea. Taking too much or too little Eliquis can result in severe bleeding or blood clot formation, respectively.

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