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Q: My doctor started me on Eliquis for atrial fibrillation. How does that prevent a stroke? When should I be worried about bleeding?

A: Doctors prescribe medications to help prevent unwanted blood clots in the heart, arteries and veins, most often to prevent heart attacks, strokes and deep vein thrombosis.

They are often referred to as “blood thinners,” even though they don’t actually alter blood viscosity.

Atrial fibrillation is one of the most common reasons people take apixaban (Eliquis) or a similar anticoagulant drug.

Atrial fibrillation can lead to small blood clots in the upper heart chamber. A clot can break off and travel to the brain, causing a stroke. An anticoagulant helps prevent that sequence.

However, anti-clotting drugs naturally increase the risk of bleeding anywhere in the body. Bleeding results from a breach in the wall of a blood vessel.

But anti-clotting drugs interfere with your body’s normal reaction to quell microscopic amounts of bleeding, which may continue unabated and become more serious.

What raises the risk?

Multiple factors can magnify a person’s risk of bleeding, especially advancing age. Older people are more likely to have one or more other health conditions that make them prone to bleeding. They’re also more likely to be taking an anti-clotting medication.

Certain chronic health conditions can leave people more likely to experience bleeding. For example, liver disease can affect blood levels of factors involved in clotting, and kidney disease can affect normal platelet function.

Blood vessel changes related to diabetes and cancer can also predispose people to bleeding.

One large group of medications that increase bleeding risk are nonsteroidal anti-inflammatory drugs (NSAIDs), including the over-the-counter pain relievers ibuprofen (Advil) and naproxen (Aleve), as well as prescription NSAIDs, such as celecoxib (Celebrex) and diclofenac (Cambia, others).

Warning signs

What are the warning signs? Some people who take anti-clotting drugs notice bleeding after shaving with a razor, or they have nosebleeds that take longer than usual to stop.

Frequent or large bruises (especially on the trunk of the body) are a potentially worrisome sign. Be sure to tell your doctor if you have these symptoms.

Seek medical care right away if you have more serious symptoms. These include tea-colored, pink or red urine (possible bleeding in the urinary tract); blood in your stools or black, tarry stools (possible gastrointestinal bleeding); or a sudden, severe headache (possible bleeding in the brain).

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, visit health.harvard.edu.

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