Eliquis (apixaban) is a widely prescribed oral anticoagulant medication. It functions as a blood thinner, commonly prescribed to reduce the risk of serious blood clots that can lead to a stroke, deep vein thrombosis (DVT), or pulmonary embolism (PE). Because this medication alters the body’s natural clotting ability, patients often seek information regarding potential side effects. This article explores the connection between taking apixaban and the possibility of experiencing changes in vision or specific eye issues.
How Eliquis Affects Eye Health
The primary way Eliquis interacts with eye health is by reducing blood coagulation. By inhibiting the clotting process throughout the body, the medication increases the potential for bleeding, including within the delicate, highly vascularized structures of the eye. This increased risk applies to various tissues, from the exterior surface to the innermost layers responsible for sight.
A common, less severe manifestation is a subconjunctival hemorrhage. This event presents as a bright red, painless patch on the white part of the eye, caused by a tiny broken blood vessel just beneath the clear conjunctiva. While often alarming, these surface bleeds are generally benign and typically resolve without intervention. These minor hemorrhages are reported in one to ten percent of patients taking apixaban.
Identifying Hemorrhagic Ocular Events
Intraocular hemorrhages are a more serious concern than surface bleeds, as they involve bleeding deeper within the eye’s structure and can threaten vision. These bleeds include retinal hemorrhage, affecting the light-sensitive tissue at the back of the eye, and vitreous hemorrhage, occurring in the gel-filled space between the lens and the retina.
Symptoms of these deep bleeds manifest suddenly and require immediate attention. A retinal hemorrhage may cause sudden vision loss, blind spots, or general blurring. A vitreous hemorrhage often presents with new floaters, described as cobwebs, haze, or shadows moving across the field of view. Substantial bleeding can lead to significant or complete vision loss in the affected eye.
Other severe events include choroidal hemorrhage, which involves bleeding in the layer of blood vessels between the retina and the outer layer. Bleeding into the anterior chamber, known as a hyphema, can also occur spontaneously, causing blurry vision, pain, and light sensitivity. Recognizing these symptoms is important because the location and amount of blood determine the severity and necessary medical response.
Understanding the Underlying Mechanism and Risk
The mechanism behind this potential side effect is the drug’s direct action on the clotting cascade. Apixaban works by specifically inhibiting Factor Xa, an enzyme crucial for forming fibrin, the protein that stabilizes blood clots. By blocking Factor Xa, the medication slows the coagulation process, reducing the risk of pathologic clot formation.
This systemic reduction in clotting ability interacts with the specific anatomy of the eye, which contains numerous delicate, high-pressure blood vessels. When these vessels rupture, the body’s slowed clotting response allows blood to accumulate in spaces where it interferes with light transmission or damages sensitive tissue. This results in the hemorrhagic events observed in some patients.
Certain patient characteristics increase the risk of an ocular bleed while on apixaban. Advanced age is a general risk factor, as is the presence of pre-existing conditions that compromise vascular health. Patients with uncontrolled hypertension or diabetic retinopathy are at greater risk because their retinal blood vessels may already be fragile. Recent eye surgery or trauma can also create a localized vulnerability, increasing the potential for bleeding.
Guidelines for Reporting Vision Changes
Patients must differentiate between minor events and serious changes that warrant urgent medical evaluation. A minor, painless red spot on the white of the eye that does not affect vision is likely a subconjunctival hemorrhage and requires monitoring. However, any sudden change in visual acuity, the appearance of new floaters, or the presence of eye pain should be treated as a medical emergency.
If a vision change occurs, immediately contact the prescribing physician and an ophthalmologist. Clearly describe the symptoms, including the onset, duration, and whether the vision loss is partial or complete. Patients must never discontinue Eliquis on their own, even if a bleed is suspected, as stopping the anticoagulant abruptly significantly increases the risk of a life-threatening stroke or other clotting event.
The medical team will assess the severity and location of the bleed to determine the safest course of action, which may involve observation or intervention. Accurate and timely reporting ensures the balance between preventing blood clots and managing bleeding risk is maintained.