Apixaban: twice-daily anticoagulant, uses and bleeding precautions

Apixaban is an anticoagulant. The NHS lists four main purposes: preventing blood clots after surgery, preventing clots after knee or hip replacement, treating deep vein thrombosis and pulmonary embolism, and preventing stroke and clots in people with atrial fibrillation.

Most adults can take it, and children weighing over 35kg may be prescribed it. The exact tablet strength and schedule depend on the reason, so follow the label from your prescriber.

It is usually taken twice a day, at consistent times, with or without food. If you struggle to swallow tablets, the NHS information says they may be crushed and mixed with water, apple juice or apple purée, following the included instructions.

If a dose is missed, take it as soon as you remember and then carry on at your normal times; if you are unsure, ask your pharmacist or doctor. If you take too much, call NHS 111, and do not drive to A&E; call 999 for an ambulance if advised.

The NHS lists these reasons for it not to be used: a past allergy or serious reaction to apixaban or other anticoagulants, active heavy bleeding, conditions that raise bleeding risk such as stomach or bowel ulcers, a recent bleed in the brain, liver or kidney disease, pregnancy and breastfeeding.

Tell your prescriber about any liver or kidney problems, since both appear on the NHS list of reasons for caution.

Bleeding is the effect to expect and watch for: bleeding for longer than usual, nosebleeds, bleeding gums, easier bruising and heavier periods. Anaemia, with tiredness and pale skin, nausea and a rash are also reported.

Contact NHS 111 about heavy bleeding or blood in urine, stool or vomit, coughing up blood, bleeding from a surgical wound, symptoms of a bleed in the brain (headache, confusion, slurred speech), any head injury, or low blood pressure with dizziness and a rapid heartbeat. Anaphylaxis, shown by a swollen throat or tongue, an itchy rash and breathing difficulty, is a 999 emergency.

The NHS names other anticoagulants such as warfarin, antifungal medicines, blood pressure and heart medicines, SSRI antidepressants, anti-inflammatory painkillers, St John's wort and HIV medicines such as ritonavir as able to interact. Check every new medicine with a pharmacist.

You can eat and drink as normal while taking apixaban. Carry the anticoagulant alert card at all times and show it before any medical or dental procedure.

Apixaban is not used during pregnancy, and the NHS says it should not be used while breastfeeding. Tell your doctor straight away if you become pregnant or are planning to.

Treatment lengths vary widely, and the NHS page does not set a fixed duration. Never stop unless the prescriber says so, because the protection depends on regular dosing.