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Eliquis Side Effects and Usage

What is Eliquis?

Eliquis is the brand name given to the drug apixapan by its manufacturer Bristol-Myer Squibb (BMS). Eliquis belongs to a class of drugs called anticoagulants, commonly known as blood thinners. Although anticoagulants like Eliquis do not technically thin the blood, they do prevent the blood from clotting as it normally would. According to BMS, this quality makes Eliquis an appropriate treatment for a variety of conditions that share a likelihood of or susceptibility to blood clots.

Among so-called blood-thinning agents, Eliquis falls within a subgroup known as Direct-Acting Oral Anticoagulants (DOACs). DOACs were designed as a new generation of anticoagulants intended to overcome many of their predecessors’ shortcomings. DOACs were supposed to be faster acting, to require less frequent monitoring of patients, and to necessitate fewer lifestyle changes than earlier drugs.

Examples of Direct-Acting Oral Anticoagulants (DOACs) include:

• Eliquis (apixaban)
• Pradaxa (dabigatran)
• Xarelto (rivaroxaban)
• Savaysa (edoxaban)

Among the intended improvements, however, DOACs also brought with them added complications. For example, whereas in an emergency situation the anti-clotting effects of the conventional anticoagulant warfarin could be offset by administering Vitamin K, most DOACs—including Eliquis—have no known reversal agent, increasing the risk of uncontrolled bleeding.

The US FDA has approved Eliquis (apixapan) for the following uses:

• Reduction of Risk of Stroke and Systemic Embolism in Nonvalvular Atrial Fibrillation (AFib)
• Prophylaxis of Deep Vein Thrombosis (DVT) Following Hip or Knee Replacement Surgery
• Treatment of Deep Vein Thrombosis (DVT)
• Treatment of Pulmonary Embolism (PE)
• Reduction of the Risk of Recurrence of DVT and PE

How does Eliquis work?

In essence, Eliquis and drugs like it work by interfering with blood’s ability to clot naturally. How exactly they accomplish this varies from substance to substance, but generally anticlotting drugs can be divided into two main categories based on how they operate: antiplatelet agents and anticoagulants. The manner in which these anticlotting drugs function dictates the uses for which they are most appropriate.

In order to understand how drugs like Eliquis work to interrupt the blood’s natural clotting mechanisms, it first is important to recall a few things about blood clotting itself. Blood clots form when platelets and proteins within the blood become denser, converting from liquid to a semisolid. As a result, clotted blood consists mostly of platelets and fibrous proteins known as fibrins.

Blood flowing through the body contains different proportions of platelets to fibrins depending on where in the circulatory system the blood is located. Arteries—which carry nutrient- and oxygen-rich blood outward from the heart to the body’s periphery—contain blood that is considerably more platelet-dense than the blood found in veins. This difference in composition holds for arterial blood clots and venous blood clots, as well: arterial blood clots contain more platelets than venous blood clots, which in turn contain more fibrin.

Antiplatelet agents, just like their name suggests, prevent blood clots by targeting platelets, which the drugs render too “slippery” to form the bonds necessary for clotting. The targeting of platelets makes these drugs more appropriate for use against arterial blood clots.

Anticoagulants like Eliquis, on the other hand, work by limiting the formation of fibrins, making them more effective in the prevention of venous blood clots. Sidebar: An Antidote for Medication?

When we think of an antidote, we normally think of a counteragent against poison, not medicine. So why did the FDA require that the Eliquis label contain the statement: “A specific antidote to ELIQUIS is not available”?

As a powerful anticoagulant, Eliquis (apixapan) can help prevent the formation of blood clots within the body. Unfortunately, this also means that Eliquis prevents blood from clotting as it normally would in other situations, as well, potentially resulting in serious—even fatal—bleeding. With no available antidote to Eliquis’ anticlotting effects, in an emergency, this means there may be no way to stop the bleeding in time.

How is Eliquis taken?

Eliquis is taken orally in pill form, with most patients taking a 5 mg dose twice daily. The FDA recommends a reduced, 2.5 mg dose for patients demonstrating at least two of the following three traits:

• The patient is 80 years of age or older.
• The patient weighs 60 kilograms (roughly 133 pounds) or less.
• he patient has serum creatinine of 1.5 mg/dL or more.

The FDA and Eliquis: A History

Pre-FDA Approval: The trouble with Eliquis began before the drug even was approved by the United States Food and Drug Administration (FDA). In fact, FDA approval was originally postponed for nearly a year after it was revealed that there had been serious irregularities and even signs of a cover up taking place at clinical trial site located in China. Ultimately, the FDA concluded that this trial—known as the Apixaban for Reduction in Stroke and Other Thrombotic Events in Atrial Fibrillation (or ARISTOTLE) trial—had failed to report a number of serious adverse events, including fatalities. Additionally, it was demonstrated that due to sloppy procedures, certain patients in the trial had been assigned the wrong drug or the wrong dosage, bringing into question the validity of any findings resulting from the study, which did not undergo peer review. Despite FDA documentation of these flaws, the ARISTOTLE study ultimately was published in the New England Journal of Medicine, to some controversy (see sidebar).

December 2012: Despite concerns over the reliability of the ARISTOTLE study, the FDA approved Eliquis as a means of reducing the risk of stroke and clogged arteries in patients suffering from atrial fibrillation (AFib), a kind of irregular heartbeat. The FDA-approved label warned that Eliquis can cause serious, potentially fatal bleeding and states that Eliquis is not recommended for use by individuals with prosthetic heart valves. The most common adverse reactions were reported to be related to bleeding. The most prominent warning label states the dangers of discontinuing Eliquis, cautioning that doing so “places patients at an increased risk for thrombotic events” including stroke. The FDA mandates that the Eliquis label include a Black Box Warning, the FDA’s highest level of warning, intended to denote instances of serious or life-threatening risk.

March 2014: The FDA issues a requirement that Eliquis’ label contain a Black Box Warning, informing patients and doctors of the increased risk of spinal and/or epidural hematoma while taking Eliquis. Sidebar: The ARISTOTLE Trials – A Case Study in Big Pharma and Big Government Working Hand-in-Hand to Maximize Corporate Profit to the Detriment of Patients

When the New England Journal of Medicine proceeded with publication of the controversial ARISTOTLE study in September 2011, it spurred controversy from many observers, some of whom called it a quintessential example of the cozy relationship among Big Pharma, government regulators, and medical professionals. Despite documented problems with the manner in which the study was conducted and questions about the validity of its data—including the discovery that deaths had gone unreported—the generally well-regarded New England Journal proceeded with publication of the non-peer-reviewed study that had been funded by Eliquis makers Bristol-Myers Squibb and Pfizer.

Dr. Arnold Relman, professor emeritus at Harvard Medical School and a former New England Journal of Medicine editor, emerged as one of the ARISTOTLE study’s chief critics, claiming that he would not have approved publication of such a flawed study while editor of the publication. Aside from the study having not been peer reviewed, Relman identified as other serious flaws:

Eliquis Insights:

• The study’s omission of the fact that Eliquis had shown no measurable benefit over a cheaper generic alternative in a subset of 7,000 European patients

• A procedural error resulting in over one-third of patients that were assigned a generic alternative being given too low of a dose to be effective, potentially exaggerating the difference between the generic alternative and Eliquis

The main danger posed by the publication of such a study, according to Dr. Relman, is that doctors who trust a long-standing publication such as the New England Journal of Medicine will be likely to believe the ARTISTOTLE study’s flawed findings and will prescribe more Eliquis as a result.

Have there been any product recalls of Eliquis?

In June 2017, Bristol-Myers Squibb issued a voluntary recall of one lot of 5 mg Eliquis tablets that had been distributed nationwide to wholesalers and retailers in the United States during February 2017. The voluntary recall was issued after a customer discovered that an Eliquis package labeled as containing 5 mg tablets in fact contained 2.5 mg tablets. Though no other instances were reported, Bristol-Myers Squibb issued the recall as a precautionary measure. Sidebar: Who should not take Eliquis?

The FDA has identified several groups of people for whom Eliquis is either untested or for whom it poses too high a risk. These include patients:

• With artificial heart valves • Who suffer from abnormal bleeding
• Who have had an allergic reaction to Eliquis
• With certain kidney or liver problems
• Who are pregnant or planning to become pregnant
• Who are breastfeeding or who plan to breast feed

Eliquis and Atrial Fibrillation (AFib)

Did you know?

According to the American Heart Association, approximately 1 out of 5 people who have a stroke suffer from atrial fibrillation (AFib).

What are the symptoms of AFib?

Although atrial fibrillation (AFib) may be present even in the absence of symptoms, according to the National Institutes of Health (NIH), the most common symptoms of AFib include:

•Accelerated heartrate
• Difficulty breathing
• Weakness
•Lack of Energy
•Chest Pain
•Lightheadedness, confusion, dizziness

How is AFib diagnosed?

In exploring a potential case of atrial fibrillation (AFib), healthcare professionals often will explore factors such as family medical history and physical symptoms prior to conducting an electrocardiogram, which allows them to view the heart’s electrical activity and identify any abnormalities.

What are the major health consequences associated with AFib?

Patients suffering from atrial fibrillation (AFib) can have a higher risk of stroke, heart attack, and heart failure. According to the American Heart Association, approximately 20% of all people who have a stroke suffer from AFib.

What causes AFib?

Atrial fibrillation (AFib) is caused by an interference with the ability of electrical signals to pass through the heart as usual. This interference, in turn, often is the result of damage caused by other heart-related conditions such as high blood pressure and coronary heart disease.

In some cases the cause of AFib is undetermined. Additional risk factors include age and inflammation.

What are the risk factors associated with AFib?

According to the National Heart, Lung, and Blood Institute—one of the National Institutes of Health—risk factors and/or triggers for atrial fibrillation (AFib) include the following:

AFIB Risk Factors:

• High blood pressure
• Coronary heart disease (CHD)
• Heart failure
• Rheumatic heart disease
• Structural heart defects, such as mitral valve prolapse
• Pericarditis (inflammation of the membrane surrounding the heart)
• Congenital heart defects
• Sick sinus syndrome (a condition involving misfiring of the heart’s electrical signals)
• Obesity
• Hyperthyroidism
• Diabetes
• Lung Disease
• Alcoholism (especially binge drinking)
• Caffeine
• Stress

How is Eliquis intended to help those suffering from AFib?

While not intended to treat atrial fibrillation (AFib) itself, Eliquis is intended to lower the chances of blood-clot formation in individuals with AFib, thereby reducing the risk of stroke and other serious complications resulting therefrom.

As described in more detail above, atrial fibrillation (AFib) can result in the formation of blood clots within the heart’s two upper chambers, the atria. These blood clots can then cause a number of serious health conditions, particularly when pieces of a clot escape the heart and enter other parts of the body, such as the lungs and brain.

Therefore, the theory goes, an anticoagulant such as Eliquis can help lower the risk of stroke and other blood-clot-related complications in those suffering from AFib. Sidebar: Blood Clots

The ability of blood to clot is a vital evolutionary adaptation that prevents every minor cut, bruise, or abrasion from potentially becoming a life-threatening situation. However, sometimes blood will clot within the body for seemingly no reason.

Blood clots, a condition also known as hypercoagulability, are potentially very dangerous. These “gel-like clumps of blood”—as the Mayo Clinic describes them—can become lodged in veins and arteries, obstructing the flow of blood to certain parts of the body.

A blood clot is created when the blood’s platelets and plasma proteins become denser, forming a semisolid mass. This means that blood clots consist mostly of platelets accompanied by woven strands of proteins, known as fibrin.

While all blood clots contain these two core components—platelets and fibrin—the composition of blood clots vary based on whether the clots are located in veins or arteries. While clots in veins consist mostly of fibrin, clots in arteries are made largely of platelets.

This difference in blood-clot composition means that different drugs are effective against different types of blood clots. Anticoagulants—including Direct-Acting Oral Anticoagulants (DOACs) like Eliquis—target the formation of fibrin, making them most effective against blood clots in veins. Conversely, non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, prevent platelets from clinging together to form clots and are therefore used to treat arterial clots.

What can I do to lower my risk of AFib?

According to the National Heart, Lung, and Blood Institute, practicing lifestyle habits associated with a reduced risk of heart disease may lower your chances of atrial fibrillation (AFib). These heart-healthy habits include exercising regularly, not smoking, and eating a diet that consists mostly of fruits, vegetables, and whole grains while avoiding excess cholesterol, trans fat, and saturated fat.

For patients seeking to prevent AFib who already have heart disease, a doctor may recommend certain measures such as following the DASH eating plan, limiting alcohol consumption, and maintaining healthy levels of triglycerides and cholesterol, with medication if necessary. Are there treatments other than Eliquis available for people with AFib?

Yes, for patients who are suffering from atrial fibrillation (AFib) and are looking for ways to lower their risk of blood clots and stroke, Eliquis is far from the only treatment option.


Like Eliquis, most medications for AFib seek to address the risk of blood clots and stroke. Some medications attempt to correct the heart rate or heart rhythm directly, but in many instances rectifying the AFib itself can prove far more challenging than limiting the risk of complications resulting therefrom.

Thus, AFib medications can be divided into three general types: medications addressing blood clots, medications controlling heart rate, and medications controlling heart rhythm. Sidebar: Arterial Blood Clots vs. Venous Blood Clots

Because arteries flow outward from the heart to the body and veins flow from the body back to the heart, blood clots can cause different complications depending on whether they are located in an artery or a vein.

Arterial blood clots are associated with:

• Stroke
• Heart attack
• Peripheral arterial clots
• Gangrene

Venous blood clots are associated with:

• Pulmonary embolism (blood clot in lungs)
• Deep vein thrombosis

Medications addressing blood clots

The first category of AFib medications includes those drugs—like Eliquis—that seek to limit the risk of serious complications associated with AFib by preventing the formation of blood clots and/or treating existing ones. This category of medication can further be divided into two groups: antiplatelets and anticoagulants.


Antiplatelets are anti-clotting medications that work by preventing platelets in the blood from attaching to one another and forming blood clots. Some of the most frequently used antiplatelet agents are aspirin, ibuprofen, clopidogrel, dipyridamole, prasugrel and ticagrelor.

Because the blood clots found in arteries are more platelet-dense than clots found in veins, antiplatelet agents typically are prescribed for treatment of arterial blood clots.


Anticoagulants such as Eliquis are frequently referred to casually as blood-thinners, and, while they do not actually thin the blood, they do prevent the blood from clotting. Unlike antiplatelet agents, however, anticoagulants target the formation of fibrin, the proteins that form the basis of venous blood clots.

Beyond Eliquis (apixaban), other examples of popular anticoagulants include heparin, warfarin, fabigitran, and rivoraxaban. Anticoagulants have been demonstrated to be most effective in preventing the formation of new blood clots and limiting the growth of existing blood clots, and less effective in reducing the size of or eliminating existing blood clots.

Eliquis belongs to a class of anticoagulants known as Direct-Acting Oral Anticoagulants (DOACs), which are newer than conventional anticoagulants like warfarin and heparin and purportedly offer improvements over their predecessors. Whereas conventional anticoagulants might require monthly blood tests, dietary restrictions, and close monitoring for signs of bleeding, the DOACs were designed to require less stringent oversight of patients while taking effect and exiting the body more quickly than the previous generation of drugs. Sidebar: What to watch for while taking anticoagulants

The American Heart Association recommends that patients taking anticoagulant medications contact their doctor if they:

•Have an accident
•Notice bruises, blood blisters, or bleeding gums
•Begin to feel lightheaded, overly fatigued, dizzy, or nauseous
•Believe they are pregnant
•Identify red, dark brown, or black coloration in stool or urine
•Bleed excessively during menstruation
•Suffer from a long-term headache and/or upset stomach

Medications controlling heart rate

Drugs that seek to address AFib by controlling a patient’s heart rate fall under two main categories: beta blockers and calcium channel blockers. Additionally, the drug digoxin is sometimes used to treat AFib by slowing the rate not of the heart directly but of the electrical signals that travel between the atria and the ventricles.

Beta blockers are prescribed to patients suffering from AFib in order to slow their heart rates, the same quality that also makes beta blockers popular as a means of lowering blood pressure.

Popular beta blockers include:

• Atenolol
• Bisoprolol
• Carvedilol
• Metoprolol
• Nadolol
• Propranolol
• Timolol

Calcium channel blockers

Calcium channel blockers also are used to slow the heart rate in patients with AFib, with the additional effect of limiting the power of the muscle cells’ contractions.

Popular calcium channel blockers include:

• Diltiazem
• Erapamil

Medications controlling heart rhythm

Other drugs prescribed to treat AFib do so by interfering with the heart’s rhythm rather than its rate. The adjustment of heart rhythm usually is attempted after issues relating to heart rate already have been addressed. The process of using medication to reestablish a normal heart rhythm is known as chemical or pharmacological cardioversion.

Sodium channel blockers

Sodium channel blockers influence the heart’s rhythm by limiting the heart’s ability to conduct electricity.

Examples of sodium channel blockers include:

• Flecainide (Tambocon) • Propafenone (Rythmol) • Quinidine

Potassium channel blockers

Potassium channel blockers slow down the overly rapid electrical signals that result in atrial fibrillation (AFib).

Examples of potassium channel blockers include:

• Amiodarone (Cordarone, Pacerone)
• Sotalol (Betapace)
• Dofetilide

Non-Surgical Treatments for AFib

In addition to medication, there exist other non-surgical treatments for atrial fibrillation (AFib), including electrical cardioversion and ablation.

Electrical cardioversion

Unlike a chemical or pharmacological cardioversion, which attempt to correct the heart’s rhythm via medication, an electrical cardioversion seeks to do so with electricity. In a process that resembles defibrillation but delivers a much less intense shock, electrical cardioversion involves putting the patient under mild anesthesia before applying shocks to the exterior of the torso. Oftentimes this jolt of electricity proves effective in reestablishing a normal heart rhythm, but the improvement may be temporary, and frequently electrical cardioversion is followed up with treatment by medication to help maintain a healthy heart rate and rhythm.


Although numerous forms of ablation are used in the treatment of AFib, they all share the core goal of identifying and disabling the tissue responsible for the errant electrical signals that cause AFib. Ablation usually is attempted only after less intrusive methods such as medication and electrical cardioversion already have been attempted or determined to be inappropriate under the circumstances.

After the location of the misfiring tissue is identified using an electrically sensitive catheter, another catheter is then run through the patient’s blood vessel to the heart, where it destroys the affected tissue via radiofrequency, laser, or cryotherapy.

Surgical Treatments for AFib

Though by far the most intrusive treatment methods for atrial fibrillation (AFib), in serious cases where other interventions have failed, healthcare professionals may resort to surgery in an effort to cure or mitigate AFib. The most common surgeries to treat AFib are the open-heart maze procedure and the implantation of an electronic pacemaker.

Open-heart maze procedure

Open-heart maze procedure is—just like it sounds—a complex, high-risk procedure in which the heart tissue is surgically modified to reduce the incidence of AFib. During the surgery, tiny incisions are made in the top of the heart before being stitched back together. This is intended to stimulate the growth of scar tissue that then interrupts the flow of electrical signals through the heart, in particular blocking those signals that cause AFib. If all goes successfully, normal heart beat and rhythm are restored.

Pacemaker implantation

A pacemaker is an electrical instrument that is surgically implanted within the body in order to assist with the regulation of heart rate and rhythm. Pacemakers typically are implanted under the skin near the collarbone, with a wire connecting the device to the heart. While certain pacemakers are designed to send out a regular signal that maintains a steady beat and consistent contractions, others are able to detect abnormalities in the heart beat and send electrical signals to correct the problem in response.

FDA-Approved Uses of Eliquis:

Treatment of Deep Vein Thrombosis (DVT) / Prophylaxis of DVT Following Hip or Knee Replacement Surgery

What is deep vein thrombosis (DVT)?

Deep vein thrombosis (DVT) occurs when a blood clot develops in a vein that lies deep within the body, most often in the thigh or calf but also sometimes in the pelvis or arm. When the blood clot is accompanied by swelling of the vein, it results in a complication known as thrombophlebitis.

As with blood clots associated with atrial fibrillation (AFib), all or part of a deep vein blood clot can break free to form what is called an embolus, or loose clot. These emboli can become quite dangerous, such as when they enter the arteries of the lungs, which can result in a serious condition known as pulmonary embolism, or PE. (For more on PE, see below: “FDA-Approved Uses of Eliquis: Treatment of Pulmonary Embolism [PE].”) Deep vein blood clots in the thigh are more likely to break away and cause PE than are deep vein blood clots in the calf or shallower blood clots elsewhere in the body.

Due to the potential for an extremely large number of individuals having DVT but expressing no symptoms, the exact number of people suffering from DVT is unknown. However, the National Heart, Lung, and Blood Institute estimates that as many as 300,000 to 600,000 individuals in the United States are afflicted with either DVT and/or PE annually.

What are the symptoms of DVT?

Of all people with deep vein thrombosis (DVT), only about half show symptoms, making the condition sometimes difficult to detect. When signs of DVT do show themselves, they impact the leg in which the blood clot is present and include the following:

• Redness and/or swelling around the affected vein • Pain (in particular when standing or walking) • A sensation of warmth around the affected area

How is DVT diagnosed?

Beyond the fact that approximately 50% of sufferers show no symptoms whatsoever, deep vein thrombosis (DVT) can be difficult to diagnose because even when patients do show the signs of DVT, they often resemble the symptoms of other conditions. Discoloration, swelling, and pain in the lower limbs are common ailments and also can be indicators of inflammation, muscle injury, or the skin infection cellulitis.

As a result, healthcare professionals must use advanced tests in order to accurately diagnose DVT. The means of these tests range widely, from advanced ultrasound to blood tests to x-rays.

Duplex ultrasonography

Duplex ultrasonography somewhat oxymoronically utilizes soundwaves to create an image of blood flowing through the veins, allowing trained experts to identify clots and blockages.

Contrast venographyv

Contrast venography is a unique form of x-ray in which a contrast material (See section on gadolinium for more on the hazards of one particular type of contrast agent), or “dye”, is injected into the patient’s foot or ankle prior to viewing in order to provide an enhanced view of blood flow through the deep veins of the legs and hips. Contrast venography, though widely recognized as still the most accurate means of diagnosing DVT, has been largely replaced by duplex ultrasonography, which does not involve the injection of a chemical contrast agent or the use of x-rays. Contrast venography now is used most frequently when duplex ultrasonography fails to deliver a definitive diagnosis.

D-dimer blood test

When a blood clot breaks apart, it releases into the bloodstream a particular substance that then can be identified by a blood test known as a D-dimer blood test. If a D-dimer blood test comes back negative, it is unlikely that the individual has a blood clot, though the determination is less certain than with an image-based test.

Magnetic resonance imaging (MRI) / Computed tomography (CT)

While magnetic resonance imaging (MRI) and computed tomography (CT) are two advanced scanning techniques that have the ability to detect blood clots and provide images of veins, they are used less frequently in the diagnosis of DVT than are duplex ultrasonography or contrast venography.

What are the major health complications associated with DVT?

The most serious health complication associated with deep vein thrombosis (DVT) is pulmonary embolism (PE), which occurs when some or all of a blood clot becomes dislodged and travels into the lungs. If the clot completely blocks a pulmonary blood vessel, the result could be fatal.

In the long term, over 30% of those with DVT will develop a condition known as post-thrombotic syndrome (PTS). PTS can result in:

• Pain
• Swelling
• Discoloration
• Scaling
• Ulcers
• Disability

Unlike arterial thrombosis—a blood clot in an artery—deep vein thrombosis does not cause heart attack or stroke. Sidebar: Examples from the Headlines – Chris Bosh and Deep Vein Thrombosis (DVT)

Chris Bosh was a National Basketball Association (NBA) all-star and champion before his career was abruptly interrupted by the same health risks and uncertainty faced by so many who suffer from deep vein thrombosis (DVT).

As happens so often with DVT, Bosh’s problems arose quickly and without warning. Shortly after the midpoint of the 2014-15 NBA season, Bosh suddenly fell gravely ill and was hospitalized. The cause was a mystery at first—Bosh’s symptoms seemingly had come out of nowhere—but doctors ultimately identified the source of Bosh’s ailments as a blood clot that had entered his lung.

After sitting out the remainder of the 2014-15 season, Bosh was cleared to return the following year, and things appeared to be going well until that year’s NBA All-Star Game, when Bosh was forced to leave the game with what originally was believed to be a mere calf strain. However, Bosh’s healthcare providers soon discovered that this was no mere muscle strain but in fact another blood clot, this time in Bosh’s lower leg. Thankfully, on the second occasion, the blood clot was identified before it had a chance to break free, perhaps heading to Bosh’s lung as the previous one had.

While Bosh and the Miami Heat—Bosh’s team—initially sought to keep the situation private, it later was revealed that Bosh indeed had suffered from DVT, and though Bosh is a world-famous athlete compensated to the tune of millions of dollars, in many respects what he was going through was representative of the experience of so many DVT sufferers: Having suffered an initial serious health scare, Bosh thought he had recovered fully, so he returned to work. After returning to his usual routine, everything seemed back to normal, and he even continued to excel at his former level, being recognized as an industry all-star. However, just as the concern had begun to leave his mind, another blood clot. What did this mean for his career, for his life?

As with many who have DVT, Chris Bosh took anticlotting medications to prevent further clots, but given the physical nature of his trade, this also meant more time away from the job. He wanted to get back to work, back to helping his coworkers—he even offered to sign a medical waiver—but his employer would not allow him to. Aside from his employer’s concern for Bosh’s wellbeing, his employer simply would not take on the potential legal liability or the public-relations nightmare that would ensue if he were to suffer a serious injury—perhaps even death—on the job.

So, despite his ability still to perform his profession at an elite level, Bosh was prevented from engaging in his chosen career, all because of the risk and uncertainty brought on by DVT and the anticlotting medications taken to mitigate DVT’s potential complications.

How is Eliquis intended to help those with DVT?

As an anticoagulant, Eliquis can lower the risk of deep vein thrombosis (DVT) by preventing the occurrence of blood clots in the veins. Eliquis accomplishes this by inhibiting the formation of fibrins, the fibrous proteins that are the primary component of venous blood clots.

What are the risk factors associated with DVT?

Virtually anyone could develop deep vein thrombosis (DVT). However, there do exist several known risk factors, with the likelihood of a deep vein blood clot increasing with the number of risk factors. The risk factors include damaged blood vessels, reduced speed of blood flow, high estrogen levels, and certain chronic conditions.

Damaged blood vessels. Damaged veins have been associated with an increased risk of DVT. Veins can be damaged by bone fractures, severe muscle injuries, or surgery.

Reduced speed of blood flow. Slow-flowing blood also has been linked to DVT. Blood can move through veins at a reduced speed under circumstances involving limited movement, such as being confined to bed while ill or injured; sitting for long periods of time, particularly with legs crossed; or suffering from paralysis.

High estrogen levels. Increased estrogen—due to such factors as birth control medication, hormone replacement therapy, or pregnancy—also can result in an increased risk of DVT.

Certain chronic conditions. Certain chronic conditions such as heart disease, lung disease, inflammatory bowel disease, and cancer are associated with DVT.

According to the Centers for Disease Control and Prevention (CDC), other risk factors for DVT include a family history of blood clots, previous occurrences of DVT or pulmonary embolism (PE), increased age, obesity, and the presence of a genetic clotting disorder.

What can I do to lower my risk of DVT?

One of the main risk factors for deep vein thrombosis (DVT) is underdoing long periods of sitting or other forms of immobility. Thus, avoiding a sedentary lifestyle is one of the best ways to reduce one’s chances of developing DVT.

Unfortunately, in our modern society avoiding long periods of immobility remains for many more of an aspiration than a reality. However, there are still things one can do to help, the best thing being to move around as frequently as possible—every little bit helps, as the main objective is simply to increase blood flow to the legs.

When sitting for long periods of time, the Centers for Disease Control and Prevention (CDC) recommend rising from a seated position and walking around at least once every 2 to 3 hours and performing simple leg exercises while seated. These exercises include tightening and loosening the leg muscles intermittently and raising and lowering the heels while keeping the toes touching the floor. Even such simple activities can help encourage blood flow and prevent the formation of potentially dangerous blood clots.

For those at serious risk for developing DVT, anticoagulant medications such as Eliquis may be an option, though such drugs also come with their own potential complications. Sidebar: Travel Tips for Reducing the Risk of DVT

According to the National Heart, Lung, and Blood Institute, the risk for deep vein thrombosis (DVT) increases on trips with a continuous travel time exceeding 4 hours. To help limit the risk of DVT on long trips, the Institute recommends:

• Wearing comfortable, loose-fitting clothing (except for, where advised by a physician, compression stockings)

• Remaining well-hydrated

• Refraining from consuming alcohol

• Encouraging blood circulation while seated by moving the legs, flexing the leg muscles, and stretching the feet

Are there treatments other than Eliquis available to treat my DVT?

Yes, there are treatments besides Eliquis available for addressing deep vein thrombosis (DVT), but most also involve some form of anticoagulant medication. In more severe cases of DVT, a doctor may resort to other means such as thrombolytics, an inferior vena cava filter, or a thrombectomy.

Anticoagulant medications

Anticoagulant medications like Eliquis can be effective in preventing deep vein thrombosis (DVT) or limiting the growth of existing blood clots because they target the formation of fibrins in the blood, and fibrins form the basis of venous blood clots. Some anticoagulants are injectable, while others are taken orally. However, other anticoagulants—particularly other Direct Oral Anticoagulants (DOACs)—are similar in chemical composition and function to Eliquis and therefore share many of the same potential risks and side effects.

Injectable anticoagulants include:

• Unfractionated heparin

• Low molecular weight heparin

• Fondaparinux

Non-Eliquis anticoagulants taken orally include:

• Warfarin

• Dabigatran

• Rivaroxaban

• Apixaban

• Edoxaban

FDA-Approved Uses of Eliquis: Treatment of Pulmonary Embolism (PE)

What is a pulmonary embolism (PE)

A pulmonary embolism (PE) occurs when blood flow through a lung artery is obstructed. Most frequently, PE is a result of deep vein thrombosis (DVT), with blood clots that form elsewhere in the body breaking free and traveling to the lungs. The resulting condition is extremely dangerous, potentially causing long-term health consequences or even death.

Getting immediate medical assistance is extremely important in the event of a pulmonary embolism (PE). According to the National Heart, Lung, and Blood Institute, approximately 30% of untreated cases of PE result in death, with the majority of those deaths taking place within the first few hours of the PE’s occurrence. Sidebar: Pulmonary embolism (PE) is an extremely dangerous condition

If you believe you or someone around you may be suffering a pulmonary embolism, seek emergency medical assistance immediately. According to the National Heart, Lung, and Blood Institute, nearly one-third of all untreated cases of pulmonary embolism are fatal.

What are the symptoms of PE?

Although a pulmonary embolism (PE)—or blockage of a lung artery—is frequently caused by deep vein thrombosis (DVT), it is not necessary that someone be diagnosed with DVT or even show DVT symptoms in order to suffer a pulmonary embolism (PE). PE happens suddenly and begins causing damage to vital tissue just as quickly.

Because PE is such a potentially dangerous condition, it is important to know the signs and to get help right away if someone around you begins showing the symptoms, which include:

• Trouble breathing

• Increased heart rate

• Irregular heart beat

• Low blood pressure

• Chest pain, especially when breathing or coughing

• Lightheadedness

• Fainting

• Coughing up blood

How is PE diagnosed?

Pulmonary embolism can only be diagnosed through advanced tests performed by medical professionals using advanced imaging technology including computed tomographic pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scans, and pulmonary angiography.

Computed tomographic pulmonary angiography (CTPA)

• CTPA is a kind of x-ray scan that involves injecting a chemical contrast agent (See section on gadolinium for more on the hazards of one particular type of contrast agent), or dye, into one of the patient’s veins in order to create an image of the blood vessels within the lung. This image will then reveal any pulmonary embolisms (PEs) as obstructions to the flow of blood within these vessels. CTPA is the primary tool used for PE diagnosis.

Ventilation-perfusion (V/Q) scan

• Ventilation-perfusion (V/Q) scans frequently are utilized when CTPA is unavailable or unsuitable for a particular individual. In a way, a V/Q scan is two separate tests, both of which utilize the same radioactive substance to reveal information about the condition of the lungs that, taken together, can lead to a diagnosis of PE.

• During the perfusion scan, the radioactive substance is used to show where blood is flowing within the lungs, while the ventilation scan provides details about the oxygen levels in various regions, providing healthcare professionals with clues as to the presence of PE.

Pulmonary angiography

• Like computed tomographic pulmonary angiography (CTPA), pulmonary angiography involves the use of x-rays. While both techniques involve the use of a chemical contrast agent, with a pulmonary angiography, rather than the contrast agent being injected into a vein, a catheter is run through a vein all the way to the lung arteries, usually entering via an incision in the groin region. Once the catheter is in place, a contrast agent is injected through it directly into the lungs, thereby providing a detailed image of pulmonary blood flow. While the most accurate test for diagnosing PE, pulmonary angiography is also by far the most invasive.

What are the major health consequences associated with PE?

Blockage of a lung artery is a very serious condition, as it can cause oxygen to be cut off from the lungs and other vital organs. This can result in:

•Low blood oxygen levels

•Damage to tissue of vital organs

•ulmonary hypertension (increased pressure in pulmonary arteries due to tissue damage caused by PE)

How is Eliquis intended to help those with PE?

While anticoagulants like Eliquis are not powerful or fast-acting enough for use in emergency, life-threatening cases of pulmonary embolism (PE), they are used to prevent existing clots from growing and to lower the risk of additional blood clots forming.

What can I do to lower my risk of PE?

Because most pulmonary embolisms (PEs) are caused by deep vein thrombosis (DVT), in order to lower one’s risk of PE, one must lower one’s risk of DVT. As discussed further in the above section, “What can I do to lower my risk of DVT?”, the most effective thing one can do to avoid DVT (and the resulting PE) is to maintain an active lifestyle, avoiding long periods of sitting and immobility. When forced to sit for a long time, one should get up and walk around at least once every couple of hours, or, when such is not an option, stretching the feet and intermittently tightening and loosening the leg muscles can help increase blood flow through the legs during long periods of inactivity. Avoiding sitting with crossed legs also can help lower the risk of DVT, which in turn helps to prevent PE.

Are there treatments other than Eliquis available to treat my PE?

Yes, there are treatments other than Eliquis available for addressing pulmonary embolism (PE) and for lowering the risk of its recurrence. However, most of these treatments remain drug-based. (For treatments specifically dealing with deep vein thrombosis (DVT)—the most common cause of PE—see the above section, “Are there treatments other than Eliquis available to treat my DVT?”

Thrombolytics: Often called “clot busters”, thrombolytics are powerful drugs that act fast to break apart blood clots. Thrombolytics are deployed in emergency, life-threatening cases of pulmonary embolism (PE), but their high risk of side effects, including bleeding, means they are only used as a last resort.

Embolectomy: Where other treatments have proven ineffective, surgical intervention may be necessary. During an embolectomy, surgeons enter the lungs’ blood vessels to manually remove the clot and restore blood flow.

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