Monitoring for Bleeding and Thrombotic Risks in Patients Taking Plavix and Eliquis

Critical Bleeding Monitoring

Gastrointestinal bleeding, characterized by black tarry stools, coffee-ground vomitus, and abdominal pain, is a significant risk in patients taking dual therapy with Eliquis and Plavix, according to the European Heart Journal 1
Intracranial bleeding, marked by severe headache, confusion, vision changes, weakness, and numbness, is a potential complication in patients on anticoagulant and antiplatelet therapy, as reported in Chest 2
Hemodynamic instability, including dizziness, lightheadedness, rapid heart rate, and drop in blood pressure, can indicate significant blood loss in patients taking Eliquis and Plavix, as noted in Praxis Medical Insights: Practical Summaries of Clinical Guidelines 3

Patients with recent acute coronary syndrome, coronary stent placement, or atrial fibrillation with high stroke risk are at increased thrombotic danger when holding both Eliquis and Plavix, as stated in the European Heart Journal 1, 4
Recent stent placement, especially within 6 months, increases the risk of stent thrombosis when both antiplatelet and anticoagulant are held, according to the European Heart Journal 4
Atrial fibrillation with high CHA₂DS₂-VASc score increases stroke risk while off anticoagulation, as reported in the European Heart Journal and Chest 1, 5

The European Heart Journal recommends avoiding omeprazole and esomeprazole with clopidogrel, as these PPIs reduce clopidogrel effectiveness 1
Renal clearance of apixaban is approximately 27%, so its effect may be prolonged in renal impairment, as noted in Praxis Medical Insights: Practical Summaries of Clinical Guidelines 6

The European Heart Journal suggests that apixaban can usually be resumed 24-48 hours after hemostasis if bleeding was the reason for holding, although this decision should be made by a provider 1, 3
Clopidogrel can be resumed within 2-3 days if high thrombotic risk, such as recent stent placement, is present, as stated in Praxis Medical Insights: Practical Summaries of Clinical Guidelines 3

The European Heart Journal advises against adding aspirin or other blood thinners without provider approval, due to increased bleeding risk 1
Patients with GI bleeding risk factors, such as elderly, prior GI bleed, alcohol use, or steroids, should be on a PPI for gastric protection while on dual therapy, but avoid omeprazole/esomeprazole with clopidogrel, as recommended by the European Heart Journal 1