People with atrial fibrillation have a five times higher risk of having a stroke. If you have atrial fibrillation, your doctor should assess your individual risk of a stroke and discuss whether you should be started on medication to reduce this risk.

What is apixaban for?

Apixaban is an anticoagulant, sometimes referred to as a ‘blood thinner’, used to lower the risk of blood clots developing in people who have atrial fibrillation (an irregular heartbeat) and other risk factors for stroke. Having atrial fibrillation increases the risk of a blood clot forming in the heart. If this clot travels to the brain, it may cause a stroke. Taking apixaban slows down the time it takes for your blood to clot and reduces the risk of this happening.

For patients with non-valvular atrial fibrillation, is it worth changing from warfarin?

Warfarin has been prescribed for more than 60 years so there is plenty of experience of its clinical use. There is evidence that apixaban is as effective as warfarin at preventing a stroke, with a smaller chance of major bleeding. If warfarin is not well controlled your GP or healthcare specialist may recommend changing from warfarin to reduce the risk of a stroke or bleeding.

Does apixaban cause less bleeding than warfarin?

As both apixaban and warfarin affect blood clotting, people may still experience side effects such as bruising and bleeding.

Evidence has shown that apixaban has a lower risk of intracranial bleeding (bleeding into the brain) than warfarin. Gastrointestinal (stomach and bowel) bleeding is also a concern, however, apixaban did not increase the risk of gastrointestinal bleeding when compared to warfarin in clinical trials.

Please seek medical advice if you have any new or unexpected gastrointestinal symptoms (e.g. indigestion, stomach-ache) or if you notice any blood in your faeces, urine or vomit.  

If a patient has excessive bleeding, can the anticoagulant effect of apixaban be reversed?

There is a drug called Andexanet alfa that can be used to reverse gastrointestinal bleeding in people taking apixaban. If urgent treatment is required for bleeding, apixaban will be discontinued and you may be given this drug.

Are regular blood tests needed to monitor apixaban levels?

There is no need for regular blood tests with apixaban. However, a blood test is needed to measure how well the kidneys and liver are working before starting treatment and then at least once a year while on apixaban treatment.

When and how do I take this medicine?

Always take this medicine as your doctor has told you. If you do not take apixaban regularly it will not be effective, and your risk of a stroke will increase.

The dose is usually 5mg twice daily morning and night. A reduced dose (2.5mg twice daily) may be prescribed in some circumstances (older age, low body weight, poor kidney function).

Apixaban should be swallowed with water and can be taken with or without food.

What are the possible side effects of this medicine?

As this medicine slows down the time it takes for your blood to clot, most side effects are bleeding or bruising.

Tell your doctor immediately if you experience any of the following side effects: Long or excessive bleeding, exceptional weakness, tiredness, paleness, dizziness, headache or unexplained swelling.

Also report if there is any blood in the urine, vomit or if you pass black tarry or blood-stained stools.

You should seek urgent medical attention if you fall or injure yourself whilst taking apixaban, especially if you hit your head, due to the increased risk of bleeding.

What should I do if I forget to take a dose?

It is important not to skip doses. If a dose is missed, you should take apixaban as soon as you remember and take your next dose at the usual time. The dose should not be doubled to make up for a missed dose.

What should I do if I take too many tablets?

If you have taken more tablets than your prescription states, you are at a higher risk of bleeding. Contact your doctor immediately. Take your medication with you to show the doctor.

How do I store apixaban?

Do not take your tablets if the expiry date has passed (you can find this information on the tablet box). Keep the tablets in their original packaging and store them in a dry place below 25oC. Keep all medicines well out of the reach of children – it is best to lock them in a cupboard or medicine cabinet.

Apixaban may be re-dispensed in a compliance aid or blister pack.

Will apixaban interact with other medicines, food or alcohol?

There are no known interactions with specific foods or alcohol. However, excessive alcohol consumption can increase your risk of bleeding, so it is advisable not to drink more than 14 units each week.

There are some medicines that apixaban does interact with so please let anybody prescribing you medicines know the names of all medications you are taking (including prescription and over-the-counter medicines, vitamins and herbal supplements).

Should patients stop taking apixaban if they are going to have a dental or medical procedure?

Do not stop taking apixaban without first talking to your doctor or dentist. Apixaban may need to be stopped for one or two days before any planned surgery, dental or medical procedure.

You will receive an apixaban alert card (contained within the tablet box). Please carry this with you at all times.