Eliquis (apixaban) is a prescription blood thinner used to prevent and treat blood clots. It has four FDA-approved uses in adults: reducing stroke risk in people with atrial fibrillation, preventing blood clots after hip or knee replacement surgery, treating deep vein thrombosis (DVT) and pulmonary embolism (PE), and reducing the risk of those clots coming back. It’s also approved for treating blood clots in pediatric patients from birth onward.
Eliquis belongs to a class of medications called direct oral anticoagulants, or DOACs. Unlike older blood thinners such as warfarin, it works by targeting a single step in the clotting process, which makes it more predictable and easier to manage day to day.
How Eliquis Works
Your blood forms clots through a chain reaction involving dozens of proteins called clotting factors. Eliquis blocks one specific protein in that chain, factor Xa, which plays a central role in converting a precursor protein into thrombin. Thrombin is what actually turns liquid blood into a solid clot. By shutting down factor Xa, Eliquis slows the entire clotting cascade without eliminating your body’s ability to stop bleeding from a cut or scrape.
This targeted approach is what separates Eliquis from warfarin, which affects multiple clotting factors at once and requires frequent blood tests to keep the dose in range. With Eliquis, there’s no routine blood monitoring needed.
Stroke Prevention in Atrial Fibrillation
The most common reason people take Eliquis is to prevent strokes caused by atrial fibrillation (AFib), a condition where the upper chambers of the heart beat irregularly. When the heart doesn’t pump efficiently, blood can pool and form clots, which can travel to the brain and cause a stroke. Eliquis reduces that risk by keeping the blood less prone to clotting.
The landmark clinical trial behind this use, called ARISTOTLE, compared Eliquis head-to-head with warfarin in more than 18,000 patients with AFib. Eliquis proved superior on all three primary outcomes: it reduced the rate of stroke and systemic embolism, lowered the risk of major bleeding, and decreased overall mortality. Those benefits held regardless of whether patients had intermittent or persistent AFib.
The standard dose for AFib is 5 mg twice daily. A lower dose of 2.5 mg twice daily is used for patients who meet at least two of three criteria: age 80 or older, body weight of 132 pounds (60 kg) or less, or a specific marker of reduced kidney function. These factors all increase the drug’s concentration in the body, so the lower dose keeps the effect in the right range.
Treating Blood Clots in the Legs and Lungs
Eliquis is also prescribed to treat deep vein thrombosis (a clot in a deep vein, usually in the leg) and pulmonary embolism (a clot that has traveled to the lungs). Both are forms of venous thromboembolism, or VTE, and they can be life-threatening if untreated.
Treatment follows a two-phase approach. For the first seven days, the dose is higher: 10 mg twice daily. This loading phase helps rapidly reduce the clot’s ability to grow. After that initial week, the dose drops to 5 mg twice daily for ongoing treatment. Your prescriber will determine how long you stay on it based on what caused the clot and your personal risk of recurrence. Some people take it for three months, others for a year or longer.
For people who have already completed an initial course of treatment and remain at risk for another clot, Eliquis can be continued at a maintenance dose to reduce the chance of recurrence.
Preventing Clots After Joint Replacement
Hip and knee replacement surgeries carry a significant risk of blood clots forming in the legs during recovery, partly because of reduced mobility and partly because surgery itself triggers the clotting system. Eliquis is approved to prevent DVT (and the pulmonary embolism it can lead to) in adults recovering from these procedures. The typical dose for this use is 2.5 mg twice daily, started 12 to 24 hours after surgery. Duration varies: 12 days is common after knee replacement, while hip replacement patients often take it for 35 days, reflecting the longer period of elevated clot risk.
Pediatric Use
As of its most recent FDA label update in 2025, Eliquis is approved for treating VTE and preventing recurrent VTE in pediatric patients from birth onward. Children must have already received at least five days of an initial injectable anticoagulant before switching to Eliquis. Dosing in children is weight-based and differs substantially from adult dosing.
Common Side Effects
Because Eliquis reduces your blood’s ability to clot, the most significant risk is bleeding. Most bleeding events are minor: nosebleeds, bruising more easily than usual, bleeding gums, or heavier menstrual periods. Cuts may take longer to stop bleeding. These are expected effects of the drug doing its job and are generally manageable.
Serious bleeding, such as gastrointestinal bleeding or bleeding inside the skull, is less common but does occur. Signs to watch for include blood in your urine or stool, vomiting blood or material that looks like coffee grounds, coughing up blood, or sudden severe headaches with no clear cause. An FDA-approved reversal agent called andexanet alfa exists specifically for life-threatening or uncontrolled bleeding in patients taking Eliquis. It works by binding to the drug and neutralizing its anticoagulant effect, giving emergency teams a way to restore normal clotting quickly.
Medications and Supplements That Interact
Eliquis is broken down in your body through two pathways: a liver enzyme system (CYP3A4) and a transport protein (P-glycoprotein). Drugs that strongly block or rev up either pathway can push Eliquis levels dangerously high or low.
Several medications should not be combined with Eliquis at all. These include the anti-seizure drugs carbamazepine and phenytoin, the antibiotic rifampin, the HIV medication ritonavir, and certain prostate cancer drugs like apalutamide and enzalutamide. All of these dramatically speed up how fast your body clears Eliquis, potentially leaving you unprotected against clots.
On the other side, certain antifungal medications like ketoconazole and itraconazole can raise Eliquis levels and increase bleeding risk. If they can’t be avoided, prescribers typically cut the Eliquis dose in half.
Two common items people overlook are St. John’s wort and grapefruit juice. St. John’s wort can reduce Eliquis effectiveness, similar to the drugs listed above. Grapefruit juice does the opposite, inhibiting the enzyme that breaks Eliquis down and potentially raising blood levels. Small amounts are generally tolerable, but drinking it regularly or in large quantities is not recommended.
What Taking Eliquis Looks Like Day to Day
Eliquis is taken as a tablet twice a day, roughly 12 hours apart. It can be taken with or without food. Unlike warfarin, there are no dietary restrictions on vitamin K-rich foods like leafy greens, and no regular blood draws to check your clotting levels. If you miss a dose, the general guidance is to take it as soon as you remember, then resume your normal schedule. You should never double up to make up for a missed dose.
One important practical point: stopping Eliquis abruptly increases your risk of clotting events, particularly stroke in people with AFib. If you need to stop the medication for surgery or another reason, your prescriber will give you a specific timeline for when to pause and restart it. Stopping on your own, even for a few days, carries real risk.