Apixaban VTE medication

What is a DVT?

A DVT is a blood clot that forms in one of the deep veins of the body - usually in the calf or thigh of one leg.

The clot stops or restricts the normal flow of blood in the vein, leading to blood building up below the clot.

The most common signs of a DVT are:

• A cramp-like pain or soreness, often in the calf
• Swelling, usually affecting only one limb
• Change in skin colour (red/discoloured/darkened) or warmth on the affected limb

Some people with DVT do not experience any symptoms. If you do have symptoms, they may start suddenly or appear slowly over days and weeks.

DVTs can be difficult to diagnose as the symptoms are non-specific and like those of muscle pain, soreness from cramp or a muscle strain. However, if this cramp-like pain is accompanied by swelling, warmth or a change in skin colour, it is likely to be a DVT.

What is a PE?

A PE occurs when a blood vessel in the lungs gets blocked by a blood clot or part of a clot that has broken loose from a DVT and travelled through the bloodstream and into the lungs (an ‘embolus').

If the clot is large, it may restrict blood flow to the lungs and cause breathing difficulties. In extreme cases a clot in the heart may result in a heart attack or cardiac arrest.

PE is more serious than DVT and can be fatal if not immediately diagnosed and treated.

Symptoms of PE can include:

• Shortness of breath, or difficulty breathing
• A cough (with or without bloodstained mucus)
• Chest pain or discomfort
• Anxiety
• Dizziness
• A faster than normal or irregular heartbeat, or low blood pressure

How do I take apixaban?

Apixaban must always be taken twice a day. For example, one tablet in the morning and one tablet in the evening. Try to take the tablets at the same time each day.

To help you remember, try to fit in taking your tablets with a normal routine that happens twice a day, for example, brushing your teeth.

You should swallow the apixaban tablet with a glass of water. It can be taken with or without food. If you have difficulty swallowing the tablet whole, talk to your healthcare team about other ways to take apixaban.

For the first 7 days of treatment

10mg (2 x 5mg tablets) of apixaban should be taken by mouth twice a day.

Following the first 7 days

5mg (1 tablet) apixaban should be taken twice a day.

How long do I need to take apixaban?

There are 2 stages of treatment for DVT/PE

Stage 1:

The initial treatment stage – this is immediately after your doctor has confirmed a DVT or PE and lasts for 3 to 6 months.

Stage 2:

Extended treatment – this is ongoing treatment, after your initial treatment stage ends and helps to reduce the chance of having another DVT or PE. Not everyone will need to have extended treatment. Deciding if you should continue taking apixaban is a shared decision that you and your doctor will make together.

What should I do if I miss a dose of apixaban?

If you miss a dose of apixaban and it is still more than 6 hours until your next dose, take the missed dose as soon as possible.

If it is less than 6 hours until your next dose, skip the dose you missed and take the next dose at the usual time. You must then continue taking apixaban twice a day as before.

What should I do if I take too much apixaban?

If you take more apixaban than recommended, you may have an increased risk of bleeding.

Possible side effects

As with all medicines, apixaban can cause side effects, although not everybody gets them.

Like other similar medicines (anticoagulants, blood ‘thinners’), apixaban can cause bleeding that may occur in different parts of the body. Sometimes this is minor such as, your gums bleeding more easily when you brush your teeth but it can be more serious and may require immediate medical attention.

You may bruise more easily when you take apixaban.

Additional common side effects include:

• Anaemia, which may cause tiredness or paleness
• Nausea (feeling sick)
• Blood test results may show an increase in liver enzymes

Things to be aware of when taking apixaban

• If you are having any surgical or dental procedures, let the doctor or dentist treating you know that you are taking apixaban. This includes procedures such as, the insertion of a tube (catheter) or an injection into your spinal column to reduce pain. You may need to reduce or temporarily stop taking apixaban before and/or after your treatment. The health care team treating you will advise you.
• Make sure that you tell your GP, dentist or pharmacist about any other medicines you are taking, including other prescription medicines, non-prescription medicines, inhalers and supplements.
• Certain medicines and supplements such as ibuprofen (Nurofen®) can interfere with the anticoagulant effects of apixaban. They may increase the risk of bleeding or make the medication less effective. Discuss any other medicines or supplements you are taking with your pharmacist.

Reporting of side effects

If you experience any side effects, talk to your GP, pharmacist or nurse. This includes any side effects not listed in the package leaflet.

You can also report side effects directly via the yellow card website using the address below: https://yellowcard.mhra.gov.uk/

Do not take apixaban if you:

• are allergic to any of the ingredients.
• are bleeding excessively.
• have (or are thought to have) a condition that increases the risk of bleeding.
• have severe liver disease leading to an increased risk of bleeding.
• are taking other medicines to prevent blood clotting.

Important information inside your pack of (apixaban)

You will find a patient information leaflet and a Patient Alert Card inside your pack of apixaban.

You should carry the Patient Alert Card with you at all times. It is small enough to fit in your wallet or purse.

The Patient Alert Card explains the importance of taking apixaban regularly, as instructed by your doctor. It also lists the main signs and symptoms of bleeding and tells you when to seek medical attention.

Further information

Visit the following websites for more information about DVT and PE.

NHS – Deep Vein Thrombosis

Website: www.nhs.uk/conditions/deep-vein-thrombosis-dvt/

NHS - Pulmonary embolism

Website: www.nhs.uk/conditions/pulmonary-embolism

References

Eliquis (2022) Eliquis® (APIXABAN) patient teaching & resources: Eliquis Ireland, ELIQUIS® (apixaban) for patients with deep vein thrombosis or pulmonary embolism patient information leaflet.

Available at: https://www.eliquis.ie/hcp/patient-resources (Accessed: 23 February 2024)