Blood thinners, also known as anticoagulants, are commonly prescribed medications used to treat and prevent a number of serious medical conditions.

However, sometimes the treatments can also lead to serious consequences of their own due to troublesome side effects, including brain hemorrhage.

Eliquis (apaxiban) is one such anticoagulant and is part of a recently-developed class of drugs called new oral anticoagulants (NOAC). For six decades, warfarin was the blood thinner that was used as the main standard of care for patients in need of anticoagulants.

The new generation NOACs were released to the market in 2010, beginning with Pradaxa (dagibatran) and Xarelto (rivaroxaban) and then Eliquis followed in 2012.

Common Uses of Eliquis

Blood thinner medications such as Eliquis are used for a variety of conditions. Sometimes the anticoagulant is prescribed to treat an actual condition, and other times it is prescribed more as a preventative measure designed to avoid any potential complications.

The most common reasons for anticoagulant medication prescription are as follows:

• Atrial fibrillation/Stroke prevention- Atrial fibrillation is an abnormal heart rhythm where the heart beats very rapidly, causing the blood to pool in the upper chambers and not be pumped out correctly. The pooled blood can cause blood clots to form, potentially leading to a stroke.
• Congestive heart failure- Heart failure occurs when the heart cannot keep up with the body’s demand for blood, causing fluid buildup in the lungs and other tissues.
• Deep Vein Thrombosis or Pulmonary Embolism- Blood clots forming in the deep veins of the body can be very dangerous and can lead to a condition called pulmonary embolism. In a pulmonary embolism, the blood clot travels to the lung, blocks a major artery in the lung and prevents oxygen from getting to the lungs. Pulmonary embolism can be fatal.
• Heart valve replacement- As a preventative measure, when a patient receives a mechanical heart valve, anticoagulants are used to prevent clots from forming on or around the new valve.
• Obesity- Since obesity is a major risk factor for heart disease, a blood thinner may be used to prevent clots that can cause a heart attack or stroke in someone who is very overweight.
• Phlebitis- In cases where the swelling of the vein (phlebitis) is present, a blood clot can lead to blood clots being trapped in a narrower vein and could cause the blood clot to be carried to the heart, resulting in a pulmonary embolism.

Side Effects of Eliquis

All blood thinner medications have side effects, but doctors mostly feel that the benefits of the medication outweigh any potential risks to the patient. Mild side effects include skin rash, nausea, fainting, anemia and allergic reactions.

Blood thinners like Eliquis work by inhibiting the body’s natural mechanism to clot blood, thus preventing clots from forming in the first place.

However, sometimes the bleeding can get out of control, and when the body needs to form clots, it can’t. Some patients can suffer from severe bleeding events like hemorrhage on the brain, gastrointestinal bleeding or other internal bleeding.

Eliquis and Brain Hemorrhage

While Eliquis has been approved to help prevent strokes caused by blood clots, it may ironically lead to a different kind of stroke- a hemorrhagic stroke. Also known as a brain bleed, intracranial bleed, brain hemorrhage or intracranial hemorrhage, these events are caused by a damaged blood vessel in the brain.

Indications of a hemorrhage on the brain include:

• Severe headache with sudden onset
• Difficulty speaking or comprehending speech
• Vision abnormalities
• Weakness in extremities
• Tremors
• Loss of coordination or motor skills
• One-sided paralysis
• Seizures
• Swallowing difficulty or taste abnormalities

Brain hemorrhage side effects can be mild to severe in nature. The effects of a brain hemorrhage depend on the location of the bleed and how much damage has occurred before help is accessed.

For some, brain hemorrhage side effects can be minimal and patients can expect a full or nearly full recovery. For others, a hemorrhage on the brain may cause permanent, widespread damage affecting many areas of functioning, and in severe cases, a brain hemorrhage may be fatal.