Eliquis (apixaban) is a commonly prescribed anticoagulant medication. This blood thinner prevents dangerous blood clots, which can lead to conditions like stroke, deep vein thrombosis, or pulmonary embolism. Temporarily pausing Eliquis before surgery is important for patient safety and requires careful guidance from a healthcare team.
Why Pausing Eliquis is Crucial for Surgery
Temporarily stopping Eliquis before surgery reduces the risk of excessive bleeding. Eliquis inhibits Factor Xa, a protein central to the blood clotting cascade. While beneficial for preventing unwanted clot formation, this mechanism becomes a concern during surgery. The body’s natural clotting ability is needed to control bleeding at the surgical site. Even minor procedures carry a bleeding risk, making Eliquis discontinuation an important precaution.
Determining the Right Time to Pause Eliquis
No universal timeframe exists for pausing Eliquis before surgery; timing is an individualized decision by the healthcare team. Factors influencing this include the type and urgency of the planned surgical procedure. For low-risk procedures like dental work or cataract surgery, Eliquis may be paused for about 24 hours. For elective surgeries with moderate to high bleeding risk, such as major abdominal surgery, stopping Eliquis at least 48 hours beforehand is common. Very high bleeding risk procedures, including intracranial or spinal surgery, or those with neuraxial anesthesia, may require a longer pause of 72 hours or even 3 to 5 days.
Kidney function also impacts stopping time, as kidneys clear about 25-27% of Eliquis. If kidney function is impaired, the medication may remain in the system longer. For example, individuals with impaired kidney function may need to pause Eliquis for 72 hours before standard-risk procedures, or up to 96 hours (4 days) before high-risk procedures. The patient’s underlying condition and individual clot risk are weighed against surgical bleeding risk. Always follow specific instructions from the surgeon and prescribing physician.
Managing Risks During the Perioperative Period
The perioperative period, around surgery, involves balancing preventing blood clots and avoiding excessive bleeding. Not pausing Eliquis can lead to significant bleeding during the procedure, potentially complicating recovery. Conversely, pausing Eliquis increases the risk of blood clot formation, which could result in a stroke, deep vein thrombosis, or pulmonary embolism. Healthcare providers assess these competing risks for each patient.
In some high-risk situations, “bridge therapy” may be considered. This involves using a short-acting anticoagulant, such as heparin or low-molecular-weight heparin, when Eliquis is paused. However, bridge therapy is generally not recommended for most patients taking Eliquis due to its short half-life and increased bleeding risk. The decision to use bridge therapy is complex and reserved for specific patients at high clotting risk. Open communication with the healthcare team about all medications is essential to navigate these risks.
Restarting Eliquis After Surgery
Restarting Eliquis after surgery is as personalized as the decision to stop it. Timing depends on the surgery type and success, post-operative bleeding risk, and the patient’s overall recovery. The surgical team, in consultation with the prescribing physician, will determine when it is safe to resume the medication.
For procedures with a low bleeding risk, Eliquis may be restarted about 24 hours after surgery, once bleeding is controlled. For surgeries with a higher risk of bleeding, restarting may be delayed for 48 to 72 hours to ensure proper healing and minimize post-operative bleeding. Patients should never restart Eliquis without explicit instructions from their healthcare provider.