How long should you stop Eliquis before surgery?

In this article:

• How long should you stop Eliquis before surgery?
• When to restart Eliquis after surgery?

In this article

• How long should you stop Eliquis before surgery?
• When to restart Eliquis after surgery?

Eliquis, the brand name of the generic medication apixaban, is an oral anticoagulant and Factor Xa inhibitor medication that reduces the risk of a blood clot. Since apixaban will not be available until 2028, Eliquis is the go-to prescription. 

Manufactured by Bristol-Myers Squibb, Eliquis is a medical treatment for people with serious conditions such as atrial fibrillation, pulmonary embolism, or deep vein thrombosis (a blood clot in the legs).

Taking Eliquis in a perioperative period can be high-risk, though. “While its use is necessary for a variety of conditions, such as atrial fibrillation or a deep vein thrombosis (DVT), taking this drug can lead to severe, even life-threatening bleeding if used in the preoperative period,” warns Dr. Kofi Quaye, a vascular surgeon at Cardiothoracic and Vascular Surgeons. 

Due to Eliquis’s effect on blood clotting, stopping it before surgery is crucial to minimize bleeding risks. Continue reading to learn crucial information for anyone taking Eliquis who requires surgery.

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How long should you stop Eliquis before surgery?

With a half-life of about 12 hours, patients don’t have to go long without their Eliquis dose before surgery. Not stopping it too early is crucial because premature discontinuation can increase the risk of thrombotic events.

According to Dr. Andrew Shapiro, medical director of Advanced Surgical Physicians and a fellow of the American College of Surgeons, stopping Eliquis before surgery is crucial. He states Eliquis is a blood thinner that “inhibits clotting, potentially complicating surgical bleeding control.”

“Most patients will be able to hold their Eliquis for a few days, two to three, before surgery,” Dr. Shapiro says. “Depending on the reason for Eliquis, some patients may be placed on a short-acting, injectable medication while Eliquis is being held before surgery.”

Dr. Shapiro adds that when undergoing major surgeries, back surgery is an instance in which patients may have to take their last dose of Eliquis as many as four to five days prior, noting that some physicians require even longer.

Dr. Alexandra Kharazi, a cardiothoracic surgeon at Southern California Surgical, has a similar estimate of around 48 hours.

Ultimately, the timing depends on the type of surgery. Major surgeries—like abdominal or orthopedic ones—are usually the ones that require 48 hours, Dr. Quaye says. “Some minor surgeries (such as a lipoma removal or those with low risk of bleeding) can sometimes be held 24 hours before,” he continues. “These are, however, surgeon-specific and will be articulated by your physician.”

While stopping Eliquis before surgery is necessary, it does come with risks (that aren’t necessarily dire). Some of those pertain to why the person was put on the medication in the first place. “For example, if you are prescribed Eliquis in the setting of atrial fibrillation, this may expose you to a higher stroke risk during the period it is held,” Dr. Kharazi says. “However, if held for a short period and resumed after surgery, the risk is not major.”

Dr. Quaye adds that the risk varies depending on the situation and condition Eliquis is treating. To be prepared, it’s best to talk to the surgical team about the individualized size of that risk.

RELATED: Eliquis side effects and how to avoid them

When to restart Eliquis after surgery?

According to Dr. Shapiro, Eliquis is typically resumed the day after surgery if there’s been no or minimal bleeding during the procedure. “If there has been a more involved or complicated procedure with a larger amount of blood loss, the Eliquis might be held for a longer period to minimize the risk of postoperative bleeding,” he continues. “This decision is managed against the risk of blood clot formation while off Eliquis.”

Dr. Kharazi agrees that getting back on Eliquis is safe once there are no signs of postoperative bleeding. In some cases, she says, this is around the 24- to 48-hour mark.

A review in The Laryngoscope leans more toward the conservative end, suggesting patients resume apixaban two to three days after surgery. It clarifies that warfarin is a blood-thinning medication that can be resumed in 12 to 24 hours.

However, every surgery and individual is different. Another factor that may be considered is if postoperative procedures are needed. “For example, in the case of open heart surgery, we may need to do minor procedures in the postoperative,” Dr. Kharazi says. “Instead of resuming Eliquis, a heparin drip is a better idea because it has a shorter half-life and can be held six hours before the procedure.”

Before restarting Eliquis, it’s important to be aware that some post-surgery drugs may interact with it, making it more or less effective, Dr. Shapiro says. One example he lists is non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, and celecoxib, used for pain. Others include antibiotics, such as clarithromycin. 

According to Dr. Quaye, clarithromycin is an antibiotic that “may enhance the anticoagulant effect of Eliquis by inhibiting some of the enzymes in the liver, which helps clear Eliquis from the blood.” This is because Eliquis is cleared from the body through the liver. “Patients with liver disease are at an increased risk of bleeding since Eliquis will stay in their system longer before it is fully excreted,” he adds.

Additional Eliquis interactions to avoid include other anti-clotting medications (such as warfarin), selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), inhibitors and inducers of CYP3A4, and grapefruit and grapefruit juice.

With some seemingly random contradictions, patients may worry they’ll accidentally ingest something they shouldn’t. Rest assured, patients aren’t expected to know everything that is and isn’t safe to take with Eliquis without medical advice. “Your pharmacist should be able to reconcile your medications and ensure that there are no interactions, as well as make the necessary adjustments,” Dr. Kharazi says. 

Dr. Shapiro says patients should inform their healthcare provider and pharmacist of all the other medications they’re taking including prescription, over-the-counter, supplements, and herbal medications

For more information on Eliquis, check out this medical guide and fact sheet by Bristol-Myers Squibb. When refilling a prescription of Eliquis, remember to use a SingleCare prescription discount card to save up to 80% of the cost.