💊 Apixaban – Information for Older Adults
Plain-language information about apixaban in older adults. This page is for older Canadians and their caregivers. It does not replace advice from your own health-care provider.
⚠️ Blood Thinner – Important Safety Information
Apixaban is a blood thinner that helps prevent dangerous blood clots. Like all blood thinners, it increases bleeding risk. Take it exactly as prescribed, don't miss doses, and know the warning signs of bleeding.
Apixaban
Direct Oral Anticoagulant (DOAC) – "Blood Thinner"
1. What is apixaban used for?
Apixaban (brand name Eliquis) is a blood thinner (anticoagulant). It belongs to a newer class of blood thinners called DOACs (Direct Oral Anticoagulants), sometimes also called NOACs (Novel Oral Anticoagulants).
Apixaban is commonly used to:
- Reduce stroke risk in atrial fibrillation (AFib) – when AFib is not caused by a heart valve problem
- Treat blood clots in the legs (DVT) – deep vein thrombosis
- Treat blood clots in the lungs (PE) – pulmonary embolism
- Prevent new blood clots after treatment for DVT or PE
- Prevent clots after hip or knee replacement surgery
💡 Why blood clots are dangerous
In atrial fibrillation, blood can pool in the heart and form clots. If a clot travels to the brain, it causes a stroke. Clots in the legs (DVT) can travel to the lungs (PE), which can be life-threatening. Apixaban helps prevent these dangerous events.
2. How does apixaban usually help?
Apixaban works by blocking a specific clotting protein called Factor Xa:
Targets a key step in the blood clotting process
Makes it harder for harmful blood clots to form
In AFib, significantly lowers the chance of stroke
Helps prevent existing clots from getting bigger
💡 Good to know
Like other blood thinners, apixaban does not dissolve existing clots – your body does that over time. Apixaban prevents clots from growing and new ones from forming.
3. How is apixaban different from warfarin?
Apixaban is a newer type of blood thinner. Here's how it compares to the older blood thinner, warfarin:
💡 Why might your doctor choose apixaban?
For many people with AFib or blood clots, apixaban offers good protection with the convenience of no regular blood tests and fewer food interactions. Studies show it may cause less bleeding than warfarin in some situations. However, the best choice depends on your specific situation.
4. Why apixaban needs extra care in older adults
Like all blood thinners, apixaban requires careful use. In older adults:
- Bleeding risk is higher – both from the medication and from falls
- Kidney function may be reduced – affects how the body clears the drug
- Lower body weight – may affect dosing
- Other medications – may interact with apixaban
👨⚕️ Because of this, health-care providers:
📊 Dose reduction criteria
The standard dose for AFib is 5 mg twice daily. A lower dose of 2.5 mg twice daily is used if you have at least 2 of these 3 factors:
- Age 80 years or older
- Body weight 60 kg (132 lbs) or less
- Serum creatinine 133 μmol/L or higher (a kidney function measure)
Your provider will determine the right dose for you.
5. How apixaban is usually taken
⚠️ Important
Take apixaban exactly as prescribed. Missing doses or stopping suddenly can increase your risk of a blood clot or stroke.
Usually taken about 12 hours apart (e.g., morning and evening)
Pick consistent times to help you remember both doses
Can be taken either way – no food restrictions
Can be crushed and mixed with water, apple juice, or applesauce if you have trouble swallowing
❓ If you miss a dose
For AFib: Take the missed dose as soon as you remember on the same day. Then continue with your regular twice-daily schedule. Don't take two doses at once to make up for a missed dose.
If you're not sure what to do, call your pharmacist or provider for guidance.
⚠️ Don't stop suddenly!
Stopping apixaban suddenly can significantly increase your risk of stroke or blood clots. If you need to stop (for example, before surgery), your provider will give you specific instructions, which may include "bridging" with another blood thinner.
💡 Tips for remembering twice-daily doses
- Use a pill organizer with AM/PM sections
- Set two daily alarms on your phone
- Link it to daily activities (breakfast and dinner)
- Keep a backup supply in your purse or travel bag
6. Bleeding risks and warning signs
The main risk of apixaban, like all blood thinners, is bleeding. Because your blood doesn't clot as easily, cuts take longer to stop, and you may bruise more easily.
🟡 Minor bleeding (common)
May not require emergency care, but mention to your provider:
- Easy bruising or small bruises
- Minor bleeding from small cuts (taking longer to stop)
- Occasional nosebleeds that stop with pressure
- Minor bleeding when brushing teeth
🟠 Serious bleeding (call your provider)
Contact your provider soon:
- Frequent nosebleeds or ones hard to stop
- Heavy bleeding from gums
- Blood in urine (pink, red, or brown)
- Heavier than normal menstrual bleeding
- Unusual or excessive bruising
🔴 Emergency bleeding (call 911)
Seek immediate help:
- Black, tarry stools or bright red blood in stool
- Vomiting blood or material like coffee grounds
- Severe headache – the worst of your life
- Sudden confusion, weakness, or trouble speaking
- Heavy bleeding that won't stop
- Any head injury or serious fall
🚨 Head injuries are always serious on blood thinners
If you fall and hit your head, or have any head injury, seek medical attention right away – even if you feel fine. Bleeding inside the head may not cause symptoms immediately but can become life-threatening.
💜 Reversal agent available
Unlike older DOACs, apixaban now has a specific reversal agent called andexanet alfa (Andexxa) that can be used in emergencies to quickly reverse its blood-thinning effect. This is available in hospitals for life-threatening bleeding.
7. When to be extra careful with apixaban
Talk to your health-care provider if you have:
💊 Drug interactions
Some medications can increase bleeding risk or affect how apixaban works. Tell your provider about all medications, including:
- ASA/Aspirin – increases bleeding risk (sometimes used together carefully)
- NSAIDs (ibuprofen, naproxen) – increase bleeding risk significantly
- Other blood thinners (heparin, other anticoagulants)
- Some antifungals (ketoconazole, itraconazole)
- Some HIV medications
- Some seizure medications (may reduce apixaban's effect)
- St. John's Wort – may reduce apixaban's effect
🍎 Good news about food
Unlike warfarin, apixaban has no significant food interactions. You don't need to worry about vitamin K or limit green leafy vegetables. Eat a healthy, balanced diet!
8. Safety tips and lifestyle
Carry a card or wear a bracelet saying you take a blood thinner
Dentists, surgeons, anyone – they need to know before any procedure
Remove trip hazards, use good lighting, hold railings
Reduces risk of cuts while shaving
Be gentle on gums to reduce bleeding
Set reminders – twice-daily dosing is important
🍷 Alcohol
Moderate alcohol use is generally okay, but heavy drinking increases bleeding risk. Limit alcohol and avoid binge drinking. Ask your provider what's safe for you.
✈️ Traveling with apixaban
- Bring enough medication for your trip plus extra
- Keep medications in your carry-on bag
- Carry a list of your medications
- Wear your medical ID
- Know the local emergency number at your destination
- On long flights, stay hydrated and move around to prevent clots
9. When to call your doctor, nurse practitioner, or pharmacist
(Non-urgent)
Contact your health-care provider or pharmacist if:
- You miss a dose and aren't sure what to do
- You notice more bruising or minor bleeding than usual
- You're starting a new medication (prescription or over-the-counter) and want to check for interactions
- Your kidney function changes or you're told your kidneys are weaker
- You're planning surgery, dental work, or any medical procedure
- You have diarrhea, vomiting, or illness lasting more than a day
- You're having trouble affording your medication
- You want to discuss whether apixaban is still the right choice for you
10. When to call 911 or go to the emergency department
🚨 Call 911 immediately if:
- Any head injury or serious fall – even if you feel okay
- Black, tarry stools or bright red blood in stool
- Vomiting blood or material that looks like coffee grounds
- Heavy bleeding that won't stop with pressure
- Severe headache – the worst headache of your life
- Sudden confusion, trouble speaking, or weakness on one side (stroke signs)
- Sudden vision changes
- Coughing up blood
- Severe abdominal pain
Tell emergency responders you take apixaban (Eliquis), a blood thinner.
🧠 Remember "FAST" for stroke signs
Face drooping • Arm weakness • Speech difficulty • Time to call 911
Apixaban helps prevent strokes, but if stroke signs appear, every minute counts.
11. Questions to ask your doctor or nurse practitioner
You can print these questions and bring them to your next appointment:
⚠️ Important Disclaimer
The information on SeniorHealthGuide.ca is general and may not fit your exact situation. It is for education only.
It does not replace medical advice, diagnosis, or treatment. Only a health professional who knows your medical history can tell you what is right for you.
Never start, stop, or change any medication without checking with your doctor, nurse practitioner, or pharmacist.