What to Know About Apixaban Side Effects

Apixaban (brand name Eliquis) is a blood thinner used to prevent strokes, treat blood clots, and reduce the risk of clotting after surgery. Like all anticoagulants, it works by making your blood less likely to clot — which also means its most common side effect is an increased tendency to bleed.

Most people tolerate Apixaban well, but it's important to understand what's normal, what's not, and when to call your doctor. This guide covers the side effects listed in FDA labeling so you can feel confident about what to watch for.

What Is Apixaban?

Apixaban is a direct oral anticoagulant (DOAC) that works by blocking Factor Xa, a key protein in the blood clotting process. It's manufactured by Bristol-Myers Squibb and Pfizer and is one of the most prescribed blood thinners in the U.S. For a deeper look at what this medication is and how it's used, see our guide: What Is Apixaban?

Common Side Effects

The following side effects are relatively common and usually manageable. They happen because the medication is doing its job — preventing your blood from clotting as easily:

• Minor bleeding and bruising — You may notice more bruises than usual, or bruises that take longer to fade. Small cuts may bleed longer than expected.
• Nosebleeds — Occasional nosebleeds are common, especially in dry weather or if you blow your nose frequently.
• Bleeding gums — You may notice blood when brushing or flossing your teeth.
• Heavy menstrual bleeding — Women of reproductive age may experience heavier or longer periods.
• Nausea — Some patients report mild nausea, particularly when first starting the medication.
• Anemia — Chronic minor bleeding can lead to low red blood cell counts over time, causing fatigue or weakness.
• Prolonged bleeding from cuts — Even minor wounds may take longer to stop bleeding.

These side effects don't necessarily mean you need to stop taking Apixaban. However, if any of them become bothersome or worsen over time, let your doctor know.

Serious Side Effects

While less common, the following side effects are serious and require prompt medical attention:

Major Bleeding

The most significant risk with any anticoagulant is major bleeding. This can include:

• Gastrointestinal (GI) bleeding — Watch for blood in your stool (red or black/tarry), vomiting blood, or vomit that looks like coffee grounds.
• Intracranial bleeding — Sudden severe headache, confusion, vision changes, difficulty speaking, or weakness on one side of the body may signal bleeding in the brain. This is a medical emergency — call 911 immediately.
• Retroperitoneal bleeding — Unexplained back pain or abdominal pain with dizziness could indicate internal bleeding.

Spinal or Epidural Hematoma

Apixaban carries a boxed warning about spinal and epidural hematomas. If you receive a spinal injection, epidural (including for childbirth or surgery), or lumbar puncture while taking Apixaban, blood can collect near your spinal cord. Symptoms include:

• Back pain
• Numbness or weakness in your legs
• Loss of bladder or bowel control

If you experience any of these after a spinal procedure, seek emergency medical care immediately. Permanent paralysis can occur if not treated quickly.

Severe Allergic Reactions

Rarely, patients may experience allergic reactions to Apixaban, including rash, itching, swelling, or anaphylaxis. Seek emergency care if you develop difficulty breathing, swelling of the face or throat, or a severe rash.

Increased Clotting Risk After Stopping

Apixaban also has a boxed warning about premature discontinuation. If you stop taking the medication without medical supervision, your risk of stroke or blood clots increases significantly. Never stop Apixaban on your own — always talk to your doctor first.

Specific Populations at Higher Risk

Certain groups may be more likely to experience side effects or need dose adjustments:

• Older adults (80+) — Higher bleeding risk. May qualify for a reduced dose of 2.5 mg twice daily.
• Low body weight (≤60 kg / 132 lbs) — Increased drug exposure may raise bleeding risk. Dose reduction may apply.
• Kidney impairment — Patients with serum creatinine ≥1.5 mg/dL may need the lower dose. Apixaban is generally safer for kidney patients than some other DOACs, but monitoring is still important.
• Liver impairment — Use with caution in mild to moderate liver disease. Avoid in severe hepatic impairment.
• Pregnant or breastfeeding women — Limited data available. Discuss risks and benefits with your doctor.
• Patients taking other blood thinners or NSAIDs — Combining Apixaban with Aspirin, Clopidogrel, Ibuprofen, or Naproxen increases bleeding risk. See our full guide on Apixaban drug interactions.

How to Manage Common Side Effects

Here are practical tips for living with Apixaban's most common effects:

• Use a soft-bristle toothbrush to reduce gum bleeding.
• Use an electric razor instead of a blade to avoid nicks and cuts.
• Apply firm pressure for 10+ minutes if you get a cut — longer than you normally would.
• Avoid contact sports or activities with a high risk of injury.
• Wear a medical alert bracelet so emergency responders know you're on a blood thinner.
• Tell every healthcare provider — including dentists, surgeons, and urgent care doctors — that you take Apixaban before any procedure.
• Take it with food if you experience nausea, though it can be taken with or without food.
• Track your periods if menstrual bleeding increases, and report significant changes to your doctor.

When to Call Your Doctor

Contact your doctor promptly if you experience:

• Bleeding that doesn't stop after 10-15 minutes of pressure
• Unusually heavy menstrual bleeding
• Blood in your urine (pink or red)
• Frequent nosebleeds
• Unexplained fatigue or weakness (possible anemia)

Call 911 or go to the emergency room if you experience:

• Blood in your stool or black tarry stools
• Vomiting blood or material that looks like coffee grounds
• Sudden severe headache, confusion, or trouble speaking
• Sudden weakness or numbness on one side
• Back pain, leg numbness, or loss of bladder control after a spinal procedure
• Signs of a severe allergic reaction

Final Thoughts

Apixaban is considered one of the safest and best-tolerated blood thinners available. It has lower rates of major bleeding compared to Warfarin in clinical studies, and it doesn't require the routine blood monitoring that older anticoagulants demand. But like any blood thinner, it does increase your bleeding risk, and knowing what to watch for is essential.

If you're experiencing side effects or have questions about your dose, talk to your doctor — don't adjust or stop the medication on your own. And if you need help finding Apixaban at a pharmacy near you, Medfinder can show you where it's in stock right now.