Eliquis Side Effects

Eliquis and other similar anticoagulants can cause severe bleeding without the benefit of an antidote to reverse the serious and potentially deadly effect. The blood thinner has also been linked to other serious side effects and complications including the formation of blood clots and an increased risk of thrombotic events, such as stroke, occurring with the discontinuation of Eliquis, as well as debilitating and potentially life-threatening hematomas that can form within the skull or spinal regions.

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The anticoagulant (blood thinner) Eliquis has been linked to several serious side effects and complications including severe bleeding. Unlike some anticoagulants, however, Eliquis does not have a specific antidote (reversal agent) to stop serious and sometimes deadly bleeding.

Bleeding associated with the use of Eliquis most commonly results in intracranial (within the skull) bleeding (also called a hemorrhagic stroke), or gastrointestinal (GI) bleeding. Other bleeding events occurred at surgical or wound/incision sites in patients taking Eliquis following hip or knee replacement surgeries.

Without an established way to reverse bleeding in patients taking Eliquis, effects should be expected to persist for at least 24 hours after the last dose of the medication is administered.

Patients who stop taking the drug prematurely are also at an increased risk of blood clots and other thrombotic events, such as stroke, while patients who undergo certain spinal or epidural procedures can develop hematomas that can result in long-term or permanent disability and death.

Blood Clots

When a patient stops taking Eliquis prematurely, or suddenly, they are at an increased risk of developing blood clots, according to a black box warning contained in drug labeling for the drug.

Typically, a blood clot forms to stop bleeding when a blood vessel is injured. After the bleeding stops, and the area of the body where the bleed occurred is healed, the body breaks down and removes the clot naturally. But when the blood clots too much or abnormally, or when certain conditions prevent the body from dissolving blood clots properly, blood clotting can become excessive and dangerous.

Clotting in Veins, Arteries

Clots can occur in veins or arteries, which are both blood vessels that make up the body’s circulatory system. Both veins and arteries help move blood in the body, but they each function differently.

Veins

Veins are low-pressure vessels that carry blood without oxygen away from the body’s organs back to the heart. When a clot forms within a vein, it can block the blood from returning to the heart, causing pain and swelling as the blood accumulates behind the clot.

Arteries

artery plaque
Plaque build-up in an artery

Contrarily, arteries are high-pressure vessels that carry oxygen-rich blood from the heart to the body’s organs and tissues. A patient’s blood pressure is a measure of the pressure in the body’s arteries. Clotting that occurs in an artery usually results from the hardening (plaque build-up) of the artery. As the artery narrows, blood continues to be forced through the opening, potentially resulting in a rupture of the plaque. This rupture can spur the formation of a blood clot, which can lead to a blockage of blood supply to the heart (heart attack) or brain (stroke).

Risk Factors

Patients at an increased risk of developing excessive or abnormal blood clots include those with the following conditions:

  • Certain genetic disorders
  • Atherosclerosis (a disease in which plaque builds up inside the arteries)
  • Diabetes (a disease in which the blood sugar levels in the body are too high)
  • Atrial fibrillation (an arrhythmia, or a problem with the speed or rhythm of the heartbeat)
  • Overweight, obesity or metabolic syndrome
  • Taking certain medicines
  • Smoking
  • Staying in one position for a long time, such as hospital stays where one is required to stay in a hospital bed for an extended period of time, or taking a long car or plane ride
  • Cancer and cancer treatments

Complications of blood clots can include:

  • Stroke
  • Heart attack
  • Kidney problems
  • Kidney failure
  • Pregnancy-related problems

Deep Vein Thrombosis & Pulmonary Embolism

Deep vein thrombosis (DVT) results when a clot forms in a deep vein in a limb, usually affecting the deep veins in the legs. Although less common, DVT can also occur in the arms, pelvis or other large veins in the body.

Did You Know

Blood clots that form in deep veins throughout the body result in death in approximately 100,000 Americans every year.

DVT affects approximately 900,000 people in the U.S. each year, and results in up to 100,000 deaths, according to the American Society of Hematology.

PE complications can cause:

  • Permanent damage to the affected lung
  • Damage to other organs in the body from not getting enough oxygen
  • Low oxygen levels in the blood
  • Death, when the blood clot is large or there are many clots

A serious complication of DVT is a pulmonary embolism (PE), which is a sudden blockage in an artery of the lung. When a blood clot in a deep vein breaks loose and travels through the bloodstream to the lung, it results in PE and a serious, potentially life-threatening condition requiring emergency medical attention.

About half of individuals suffering from PE have no symptoms. When symptoms are present, they might include shortness of breath, chest pain or coughing up blood.

man clutching chest in pain

Signs of a blood clot can include the following symptoms at the site of the clot:

  • Warmth
  • Swelling
  • Pain
  • Tenderness
  • Redness

Other Complications of Blood Clots

A blood clot can form in, or travel to, any region of the body, including the lungs, heart or brain, as well as other organs important to the body’s essential functions. Serious complications can occur when a clot interferes with normal blood flow to the body’s organs.

Heart attack

A heart attack occurs when blood flow to the heart is blocked suddenly preventing oxygen from reaching the vital organ. Heart muscle will begin to die without immediate treatment. Heart attacks affect nearly 800,000 individuals in the U.S. each year, according to the National Institutes of Health (NIH).

The most common symptoms include:

  • Chest discomfort, usually affecting the left side of the chest – can feel like pressure, squeezing, fullness, heartburn, indigestion or pain
  • Discomfort in the upper body, including the back, shoulders, neck, jaw, one or both arms, or the upper part of the stomach
  • Shortness of breath
  • Nausea and/or vomiting
  • Dizziness and/or lightheadedness
  • Breaking out into a cold sweat

Stroke

Strokes occur when blood flow to the brain is interrupted. Brain cells begin to die within minutes. A stroke is a medical emergency.

Symptoms come on suddenly and can include:

  • Numbness or weakness in the face, arm or leg — usually affecting one side of the body
  • Confusion, trouble speaking or understanding when others speak
  • Vision problems in one or both eyes
  • Difficulty walking, dizziness, loss of balance or coordination
  • Severe headache with no known cause

Kidney failure

Blood clots that form in or travel to the kidneys can cause damage that can eventually lead to kidney failure. High blood pressure is just one the complications that can result when fluids and waste build-up in the kidneys. Treatment is needed to do the work the kidneys can no longer do. If not treated properly, kidney failure can potentially result in a coma, seizures or death.

Pregnancy complications

Blood clots that form during pregnancy usually affect the veins in the pelvic region or the legs. This puts pregnant women at an increased risk for PE. Other complications that can result from blood clots during pregnancy include premature labor, miscarriage – loss of pregnancy or death of the mother and potentially the fetus.

Treatment of Blood Clots

A thrombectomy is the surgical removal of a blood clot

Treatment involves breaking up the clots and preventing new clots from forming. This can be done with certain medicines administered orally or via a catheter surgically inserted to deliver medication directly to the site of the clot to help it dissolve. Sometimes surgery is performed to remove a clot. This is called a thrombectomy.

Patients are sometimes referred to a hematologist for treatment. A hematologist is a doctor who specializes in treating blood diseases. Patients who are at risk of arterial clots may also see a cardiologist (a doctor who specializes in conditions affecting the heart) or a neurologist (a doctor who specializes in treating disorders of the nervous system, including diseases of the brain).

Spinal or Epidural Blood Clots

Patients who receive neuraxial anesthesia or that undergo spinal puncture while taking Eliquis, are at risk of developing an epidural or spinal hematoma. These hematomas can result in long-term or permanent paralysis, according to drug labeling containing a black box warning for Eliquis.

Factors that can increase a patient’s risk of developing an epidural or spinal hematoma include:

  • Use of indwelling epidural catheters
  • Use of Eliquis with other drugs that affect hemostasis (the process that causes bleeding to stop), such as nonsteroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors or other anticoagulant drugs
  • History of traumatic or repeated epidural or spinal punctures
  • History of spinal deformity or spinal surgery

Optimal timing between taking Eliquis and undergoing a neuraxial procedure is unknown.

epidural hematoma xray

Epidural Hematoma

While the incidence of a spinal or epidural hematoma is relatively rare, it is a very serious condition that can be deadly. An epidural hematoma, which is a mass of blood that forms in the space between the skull and the protective covering of the brain, can put pressure on the brain causing it to swell. As it swells, the brain can shift in the skull, putting pressure on and damaging various parts of the brain’s tissues.

spinal compression xray

Spinal Hematoma

A spinal hematoma can result in spinal-cord compression. Compression to certain spinal roots in the lumbar (abdominal or lower spinal) portion of the spinal cord can cause a condition called causa equina syndrome (loos of function of the lumbar plexus, or nerve roots) and lower extremity paresis (partial loss of movement or impaired movement of the lower limbs).

Symptoms are often severe and can begin with local or radicular pain (pain caused by inflammation of a spinal nerve root) and tenderness. The condition can progress rapidly over a period of hours or even minutes.

Signs and Symptoms of Neurological Impairment

Signs and symptoms of neurological impairment occur in the nervous system, which consists of two parts, the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS includes the brain and the spinal cord, and acts as a central processing station. The PNS sends information received by the senses between the muscles, tissues and nerves in the body to the brain. When connections, or messages, are interrupted in the CNS or PNS, then neurological symptoms can occur.

Symptoms Vary

Neurological symptoms can also be accompanied by other systems depending on the underlying cause, disease, disorder or condition affecting the neurological systems. Signs and symptoms of a neurological problem can vary because the nervous system participates in and controls a number of functions and body systems, such as body temperature, blood pressure, muscles, digestion and appetite, movement, and sight.

Some of these neurological symptoms that may accompany other symptoms of other body systems affected by the nervous systems include:

  • Changes in smell or taste
  • Burning feeling
  • Confusion or changes in cognitive skills
  • Involuntary muscle contractions
  • Pins-and-needles (prickling) sensation
  • Fainting, extreme lack of energy or change in level of consciousness
  • Muscle weakness
  • Numbness
  • Nerve pain
  • Loss of balance/coordination
  • Sensitivity and tingling
  • Paralysis or inability to move a certain body part or parts

Neurological symptoms can sometimes occur along with symptoms related to the digestive system. These may include chewing difficulties, digestive problems and boss of bladder or bowel control. Nausea with or without vomiting may be possible.

Signs that a neurological condition may be serious or life-threatening include changes in pupil size or pupils that are nonresponsive to light. Other signs include changes in consciousness or alertness. Disorientation, dizziness and garbled speech are also warning signs. Other indicators include loss of muscle coordination, respiratory problems, seizures and sudden paralysis.

Treatment of Neurological Compromise

Treatment of a spinal or epidural hematoma will depend on the severity of the condition and the patient’s individual symptoms. Treatment can also be affected if a patient has other health conditions.

Immediate surgical drainage is usually needed to reduce pressure on the brain and the spinal cord.

Treatment might include:

Surgery

Surgery to remove the hematoma; called a craniotomy – involves opening up part of the skull.

Aspiration

Aspiration involves a small hole being cut into the skull and the use of suction to remove the hematoma; this method is usually used in treating smaller hematomas.

Medications

Medications often given prior to surgery to reduce inflammation and pressure; can also be given post-surgery to prevent further complications associated with head injuries; these medicines sometimes need to be taken for months or even years following surgery.

Rehabilitative Therapy

helps to manage symptoms and disabilities such as weakness, incontinence (inability to keep urine from leaking), difficulty walking and paralysis caused by the condition.

Home Care

recovery is a process that can take up to two years in some cases.

If not treated timely or properly, a spinal or epidural hematoma can be deadly. While it is possible to recover fully from the condition, hematomas of this nature can often result in permanent damage to the brain and long-term disability.

Please seek the advice of a medical professional before making health care decisions.

Author

Kristin Compton is a medical writer with a background in legal studies. She has experience working in law firms as a paralegal and legal writer. She also has worked in journalism and marketing. She’s published numerous articles in a northwest Florida-based newspaper and lifestyle/entertainment magazine, as well as worked as a ghost writer on blog posts published online by a Central Florida law firm in the health law niche. As a patient herself, and an advocate, Kristin is passionate about “being a voice” for others.


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