The People's Perspective on Medicine

Is There an Antidote for Xarelto or Eliquis Bleeding?

Anticoagulants prevent blood clots but raise the risk for bleeding, especially during emergency surgery. Is there an antidote for Xarelto in a crisis?

It used to be that if someone were taking an anticoagulant to prevent blood clots there wasn’t much that could be done if the patient began bleeding badly. That is probably why Johnson & Johnson and Bayer agreed to settle nearly 25,000 Xarelto lawsuits for a total of $775 million. Now there is an antidote for Xarelto and Eliquis.

This Reader Worries About Xarelto and Surgery:

Q. Is it still true that people can bleed to death if they need emergency surgery while taking the anticoagulant Xarelto? Is there anything being done about it?

A. You raise a critical question. New-generation anticoagulants such as rivaroxaban (Xarelto) and apixaban (Eliquis) carry a risk of bleeding under the best of conditions. If a patient requires emergency surgery, the possibility of hemorrhage is even greater.

An Antidote for Xarelto (and Eliquis):

Fortunately, emergency physicians and surgeons now have an antidote called andexanet alfa (Andexxa). This intravenous drug can help reverse the anticoagulation effect of Eliquis and Xarelto when patients are faced with uncontrolled bleeding.

Emergency physicians can learn more about dealing with this kind of crisis in the publication Critical Pathways in Cardiology (Sept. 2019).  It is important for people taking such anticoagulants to know when they might need to take immediate precautionary action.

Here is what the official FDA prescribing information tells doctors:

“Advise patients to report any unusual bleeding or bruising to their physician. Inform patients that it might take them longer than usual to stop bleeding, and that they may bruise and/or bleed more easily when they are treated with XARELTO

“Instruct patients to inform their healthcare professional that they are taking XARELTO before any invasive procedure (including dental procedures) is scheduled.

“Advise patients to inform their physicians and dentists if they are taking, or plan to take, any prescription or over-the-counter drugs or herbals, so their healthcare professionals can evaluate potential interactions

“Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary 

Remind patients to not discontinue XARELTO without first talking to their healthcare professional.”

People’s Pharmacy Xarelto Caution:

If you notice that your gums are bleeding after brushing or flossing, let your health professional know promptly. If you cut yourself and the bleeding won’t stop within a reasonable amount of time, let your health professional know promptly. If you start developing nosebleeds let your health professional know promptly. If you see blood in your urine, let your health professional know promptly.

Do you see a pattern here? If you see red, contact your doctor! If you experience a serious bleeding episode, get to an emergency department pronto. Remember, there is an antidote for Xarelto and Eliquis. There is also an antidote for Pradaxa (dabigatran). It is called Praxbind (idarucizumab).

Learn more about adverse reactions related to both Eliquis and Xarelto at this link:

Some Eliquis and Xarelto Side Effects NOT in the Prescribing Info

Share your own experience with Xarelto or Eliquis in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I had been on Coumadin for several years for blood clots. Recently I fell, landing on my left side. At the time I didn’t realise I was injured but I sustained a severe internal bleed in my left leg. I didn’t suffer a break and did not realise my bleed until that evening when I became dizzy. I went to the emergency room, and they found the bleed. The only remedy I received was two litres of saline and was hospitalised tor two days. Was there anything else that should have been done? I presently have been switched to Eliquis without any side effects.

Four years ago when I was on Eliquis I experienced severe nose bleeds, the worst in my lifetime. The PA told me to get my nose cauterized.

I stopped taking Eliquis and changed doctors. My diet is whole food plant-based, and so my arteries and veins are not full of fat, cholesterol, grease, and plaque.

Cardiologists love Eliquis–whether they believe it is superior to warfarin, or they’re the victims of eloquent marketing. The reality is that this and other similar drugs are fairly new, so if history is any indication, we WILL find unexpected and/or un-advertised effects.

Andexxa is VERY new. There’s little data collected to judge just how effective it is in reversing bleeding episodes and avoiding serious outcomes. Praxbind, the drug recently marketed as an antidote to Pradaxa, has shown mixed results, and I anticipate that Andexxa will have similar, lukewarm performance.

As a registered nurse whose spouse recently started Eliquis, I was anxious, and vigilant in assessing him for any side effects. He did develop petechiae (small areas of capillary leakage–in other words, bleeding) scattered all over his lower legs. Consulting his doctor, a trip to the emergency room and lab tests resulted in physicians shrugging their shoulders, since this is not a KNOWN side effect of Eliquis. He continues to take this medication (prescribed for an atrial fibrillation procedure) but will be able to change back to aspirin a month from now.

That will be a huge relief. Meantime we did report the episode to the FDA adverse events system. I have little faith in that system, but it’s the right thing to do. Nearly a month after the small bleeding areas showed up, they are finally healing and fading. We continue our vigilance.

One note: Eliquis is prescribed in a “one size fits all” dosage. There is no ability to individualize the dose since there is no testing. To my mind, this increases the possibility of both bleeding episodes and clotting problems.

I had been on warfarin for years, and this past January (2019) my cardiologist wanted me on Eliquis. The third day I started sweating profusely, was having an anxiety attack, and felt like I was having a heart attack. It took a week of complaining, and I was then put on Xarelto. This seemed fine but after taking it 2 weeks I felt very tired with no energy. Finally in May (2019) I asked my cardiologist if I could go back on warfarin. He agreed, and I’ve been fine ever since. The monthly INR’s don’t bother me at all.

Would this also be an issue if you are on other anti-platelets such as baby aspirin?

I have been on Xarelto for two years. I have experienced no side effects .

What about patients taking Coumadin/Warfarin? It is also an anti-coagulant taken by patients with danger from AF. My husband takes it and bruises and bleeds easily. One small wound he got from a scratch wouldn’t stop bleeding for 24 hours. It was a seep, not a gush, but still… I found a spray “blood stop” at the pharmacy, and that did the trick. But a serious bleed would be another matter.

There is an antidote for warfarin in the case of serious bleeding. It is called vitamin K, and hospitals keep it for that purpose.

I’ve been off xarelto for two years for Afib, which was successfully stopped by a Cardio Ablation procedure. But at the onset of taking the blood thinner the least knock or bumping into stuff would cause purple red hemorrhaging just below the skin mainly on arms and hands. I’m 57 now and after stopping the blood thinner I still have this easy bleeding under my skin. I thought that would have stopped. The splotches are quite noticeable but reabsorb over weeks. Why hasn’t this stopped?

What about just taking vitamin K for a time before the surgery? And if one is at risk for blood clotting, why not take Nattokinase regularly, since it dissolves the fibrin that causes clotting, without thinning the blood? It’s worked for me for 6 years, now, and I was very subject to DVT, having had 5 of them.

I was prescribed Eliquis for Afib. It made me extremely dizzy to the point that I blacked out and sustained a bad fall. Asked to be put on Warfarin and have used for 2 years with no negative side effects,

Would this situation also apply to those on daily baby aspirin?

What about warfarin? I had to have hand surgery when I was first taking Plavix after heart bypass surgery. I woke up soaked in blood and went to the ER immediately. They got it stopped somehow.

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