This booklet contains information for individuals

Eliquis® patient brochure

This Eliquis® patient brochure is available in 12 different languages. Ask your doctor or nurse.

If you would like to learn more information about atrial fibrillation or venous thromboembolism, visit www.blodproppsskolan.se (in Swedish).

WHAT IS ELIQUIS®?

You have received this brochure because your doctor has prescribed Eliquis® (apixaban). You either have atrial fibrillation or you have been prescribed Eliquis® to reduce the risk of stroke caused by atrial fibrillation. Or it could be that you have a blood clot in your leg or lung and have been prescribed Eliquis® to treat the blood clot.

This booklet explains common causes of your condition, common symptoms, what you can do to reduce the risk of becoming ill, practical advice during treatment with Eliquis® and more.

Some parts of this booklet are general for Eliquis® regardless of condition. There are also two sections with a specific focus, either ATRIAL FIBRILLATION or BLOOD CLOT IN A LEG OR LUNG. Be sure to read the section that applies to you.

You should also read the patient information leaflet included in the package of your medicine. This can also be found at www.fass.se.

FOR INDIVIDUALS WITH ATRIAL FIBRILLATION

Atrial fibrillation is a heart condition that causes your heart to beat fast and at an irregular rate.

Many people with atrial fibrillation do not notice any symptoms, but you may notice a fast and/or irregular heart rate. Some people describe this as “heart palpitations”. Other possible symptoms include:

  • fatigue
  • shortness of breath
  • chest pain
  • dizziness

What should I expect?

You can live with atrial fibrillation that causes attacks throughout your life. You may need treatment with medicine periodically. The frequency and intensity of attacks vary greatly from person to person. Some only have attacks every few years, while others can have several attacks in a single week. Some are unaware of their attacks, while others have clear symptoms. Life can continue as normal between attacks. The longer you have lived with recurring symptoms, the greater the chance of the atrial fibrillation becoming chronic and irreversible.

Atrial fibrillation can occur as separate “episodes”, which last from a few minutes up to several days. This is called “paroxysmal atrial fibrillation”, which simply means “atrial fibrillation that comes as attacks”. There are also forms of atrial fibrillation that can be described as “persistent” or “permanent”. This means that the condition is present all the time.

Atrial fibrillation is attributed to cells that control your heartbeat not working properly. This causes the heart’s natural pacemaker to become confused and no longer able to control the rhythm of the heart.

With atrial fibrillation, the two upper chambers of the heart do not contract completely, preventing the blood from being pumped out properly. The cavity is called an atrium, which is why the condition is called atrial fibrillation.

THE CAUSE OF ATRIAL FIBRILLATION

The exact cause of atrial fibrillation is unknown, but the risk increases with age and it is more common in people with other heart conditions.

For example

  • high blood pressure
  • clogging/blockage of the blood vessels supplying the heart
  • heart attack
  • congenital heart disease or heart disease after cardiac surgery
  • tobacco
  • coffee
  • overconsumption of alcohol
  • stress
  • heart failure
  • hyperthyroidism (when too much thyroid hormone is produced in the body)

WHAT CAN ATRIAL FIBRILLATION LEAD TO?

The biggest risk associated with atrial fibrillation is stroke.

Because the blood is not pumped out of the heart properly, it can accumulate in the heart and form a clot, which is acollection of coagulated blood. If the clot leaves the heart and enters the small blood vessels of the brain, it will block the blood flow. This, in turn, leads to a stroke.

Persons with atrial fibrillation are at greater risk of stroke than persons without atrial fibrillation.

Stroke Symptoms

A stroke can come suddenly. You must respond quickly. Here are some things you can be aware of that will help you recognise a stroke.

Check for stroke with the FAST test

FACE

Facial paralysis?
Ask the person to smile and show their teeth. Has the face fallen on one side? Does the corner of the mouth hang down?
CALL 112

ARMS

Paralysis in an arm?
Ask the person to raise their arms and hold them up for 10 seconds.
Does the person show signs of weakness/ paralysis in either arm?
CALL 112

SPEECH

Difficulties speaking, reading or understanding? Ask the person to say the following sentence: “The weather is beautiful today.”
Does the person have trouble finding words, saying the right word or is their speech slurred?
CALL 112

TIME

The symptoms come suddenly and must be treated quickly!

Other symptoms may include weakness or numbness/ paralysis of one half of the body, loss of vision or blurred vision in one or both eyes, confusion, dizziness or unsteadiness.

If you notice any of these symptoms, contact a doctor immediately.

How to reduce the risk of atrial fibrillation

When you experience atrial fibrillation attacks that seem to have been triggered by something in particular, you can try to reduce the risk of new attacks by avoiding the triggering cause. You can refrain from drinking alcohol, try to avoid stressful situations, or discuss a change of medicines with your doctor.

For many, it is impossible to do anything about atrial fibrillation attacks. For example, they may start while you are asleep. Giving up smoking, eating less fatty foods and exercising more are ways to reduce the risk of cardiovascular disease, which may reduce the risk of atrial fibrillation. You can also reduce the number of attacks with the help of medicine.

MEDCINES THAT THIN THE BLOOD

Blood thinners (anticoagulants) are medicines that cause the blood to clot (coagulate) more slowly.

This helps to prevent blood clots that cause stroke.

Your doctor has carefully assessed your risk of having a stroke and decided to prescribe the blood thinner Eliquis®.

The aim of Eliquis® is to reduce your risk of having a stroke caused by atrial fibrillation.

YOUR MEDICINE

Always take Eliquis® exactly as prescribed by your doctor.

Eliquis® is always taken twice a day, for example once in the morning and once in the evening. Try to take the tablets at the same time each day. It may help to take them in conjunction with something else in your daily routine that you do twice a day.

The usual dose of Eliquis® is one 5 mg tablet twice a day. (Some patient groups can be prescribed one 2.5 mg tablet twice a day.)

You should swallow the Eliquis® tablet with a glass of water. You can take it with or without food. The tablet can be crushed if you have difficulties swallowing.

If necessary, you can take the Eliquis® tablets out of the blister packaging and put them in a pill organiser/reminder.

You can request a package of different aids for helping you remember to take your tablets. We call this aid package “Continuum of Care”. Ask your doctor or nurse.

FOR INDIVDUALS WITH A BLOOD CLOT IN A LEG OR LUNG

A blood clot is when the blood has coagulated and formed a blockage inside a blood vessel. The clot makes it difficult for blood to pass through the blood vessel. A clot is not usually dangerous if it is detected and treated early. But, if it gets bigger it could seriously inhibit blood circulation. Blood clots occur most commonly in the legs, often starting in a blood vessel in one of the calves. It is very rare to have blood clots in both legs at the same time.

Seek medical attention

If you think you may have a blood clot, seek medical attention immediately at a medical centre or emergency room.

CAUSE OF BLOOD CLOTS IN A LEG OR LUNG

You are at increased risk of developing a blood clot in a leg or lung if you:

  • have an infection
  • are over 65 years old
  • are pregnant
  • are severely overweight
  • are a smoker
  • have cancer, particularly during surgery or if treated with chemotherapy
  • have an abnormally high number of blood cells
  • are using birth control pills or other medicines containing oestrogen.

If you do not move your body and use your calves, the blood circulation in the legs becomes slower, enabling blood clots to form more easily. Keep this in mind when sitting for a long period of time, such as on a long flight. A good tip is to do heel raises and walk around a bit when you have been sitting very still.

Blood clots in the leg or lung can form more easily if you have a disorder affecting the blood’s ability to clot or dissolve clots. Heredity can be a factor in this.

What a blood clot could lead to

If detected and treated early, a deep vein thrombosis (blood clot in a deep vein) is usually not dangerous and does not cause lasting problems. However, a blood clot in the veins of the lower leg that goes untreated and grows larger is more difficult to treat and could seriously inhibit blood circulation. A blood clot in a vein can grow several decimetres long. Such blood clots in the calf could increase in size and eventually reach the thigh and pelvic veins.

Blood clots that form in the veins of the legs or pelvis could break off, travel in the blood stream and lodge in one or both of the lungs. Sudden shortness of breath, coughing or tightness in the side of the chest while breathing could be a sign that a blood clot has travelled through the bloodstream and lodged in the lungs.

It is important that you receive treatment for your blood clot to prevent it from breaking off and travelling to the lungs, which could cause you to have difficulty breathing.

Common symptoms:

  • the calf swells and becomes warm, sometimes even red or discoloured
  • the leg feels heavy
  • the leg aches, particularly when walking or using the calf muscle
  • the calf is sore and tense if squeezed
  • superficial veins of the leg can be seen more clearly and feel sore
  • mild fever.

Treatment

To prevent blood clots in your legs, it is important to move your legs as best you can, even if you are bedridden or very sedentary. Quitting smoking and losing weight can reduce the risk of developing blood clots.

Blood clots must be treated by a doctor, who will normally prescribe you a blood thinner (anticoagulant). The treatment helps the body to dissolve the clot and open up the blood vessel again. It also reduces the risk of new clots.

If you have a blood clot in the leg, you will likely be requested to wear a compression stocking both during and after your treatment time.

HOW TO TAKE ELIQUIS®

Always take Eliquis® exactly as prescribed by your doctor. When treating clots in a leg or lung, the most common procedure for taking your medicine is as follows:

IT IS MOST COMMON to take TWO 5 mg tablets in the morning and TWO 5 mg tablets in the evening for 7 days.

You then reduce the number of tablets by half and take ONE 5 mg tablet in the morning and ONE 5 mg tablet in the evening for at least 3 months.

If blood clots have been a recurring problem, you may need to take your blood thinner for several years. Do not stop until your doctors advises you to. Otherwise, there is a risk of poor treatment outcome and a risk of relapse. Further information on how to use Eliquis® can be found in the patient information leaflet included in the package of your medicine.

WHAT TO BEAR IN MIND

Complications of blood clots in a leg or lung

Approximately 30% of individuals who have had a blood clot develop a new blood clot within 10 years. It is therefore important that you are aware of and recognise the symptoms and that you seek medical attention in time. Some patients develop a new blood clot as soon as the first few months after finishing treatment. If this is the case, you must seek medical attention immediately.

Move your legs

To prevent blood clots in the legs, it is important to use your calf muscles by moving them as best you can. When you do not use your calf muscles, there is poorer blood flow in the leg and a risk of the leg swelling up. This applies whether you are lying down, sitting or standing.

Going for walks is helpful. If you are bedridden, you can try peddling with your feet, wiggling your toes and moving your legs several times a day. The contractions of the calf muscles compress the veins and help keep the blood moving in the direction of the heart.

If you sit still for a long period of time, for example while travelling on a plane, it is a good idea to move and pedal with your feet. An even better idea is to walk around in the plane if you have the chance. You can also use compression stockings to prevent blood clots when sitting still for a long period of time, such as when travelling. Compression stockings are available without prescription from a pharmacy or shops selling various types of aids. You should always ask the salesperson for advice on size.

Quitting smoking and losing weight can likely reduce your risk of developing blood clots in the veins over time.

WHAT TO THINK ABOUT WHEN TAKING ELIQUIS

What do I do if I have taken too much Eliquis®?

Tell your doctor or nurse immediately if you have taken more than the prescribed dose of Eliquis®. Take the medicine package with you to the doctor, even if there are no tablets left. If you take more Eliquis than recommended, you may have an increased risk of bleeding.

If you are going to have any surgery, biopsy or dental treatment, tell your doctor or dentist that you are taking Eliquis®. You may need to stop taking Eliquis® altogether or take a break from the treatment.

Also remember to tell your doctor or dentist if you are taking any other medicines, including non-prescription medicines and natural remedies (e.g. St John’s wort).

It is a good idea to wear the Eliquis® necklace and carry the Eliquis® card in your wallet. This is a good “insurance policy” in case you are in an accident, whether abroad or in Sweden.

Some medicines and dietary supplements could disrupt the blood-thinning effect of Eliquis® and either put you at increased risk of bleeding or decrease the effect of the medicine.

A full list of medicines that could affect Eliquis® can be found in the patient information leaflet provided in the medicine package.

Do not take Eliquis® if you are pregnant or breast-feeding or if you have a liver disease or bleeding disorder, unless otherwise advised by your doctor after he has received this information. It is important to inform your doctor if any of this applies to you.

How long will i take Eliquis®?

The length of treatment with Eliquis® may vary. Some people may need to take it indefinitely. You should always follow your doctor’s instructions and continue taking your medicine for as long as your doctor instructs you to.

DO NOT STOP TAKING ELIQUIS® WITHOUT TALKING TO YOUR DOCTOR FIRST!

What do I do if I miss a dose?

If you forget to take a dose of Eliquis®, take the tablet as soon as you remember. Then take the next Eliquis® tablet at the usual time and continue as normal. If you are not sure what to do, ask your doctor or the person administering your medicine.

Possible side effects

Like all medicines, Eliquis® can cause side effects, although not everybody gets them.

More information about side effects can be found in the patient information leaflet provided in the medicine package.

As with similar medicines (blood thinners), Eliquis® could cause bleeding which may require immediate medical attention.

Other known side effects include bruising, blood in the urine (that stains the urine pink or red), nose bleeds and nausea. If you experience unexpected bleeding, contact your doctor or nurse.

Inform your doctor, pharmacist or nurse if you experience any side effects. This includes any side effects not listed in the patient information leaflet or this booklet.

Always inform your doctor and dentist that you are taking Eliquis®. If you need to have surgery or a dental procedure, always inform the doctor or dentist that you are taking Eliquis®, as you may need to temporarily stop taking the medicine one or two days before the operation or dental procedure, e.g. tooth extraction.

Healthy Living

Your medicine in combination with a healthy lifestyle will help you manage your atrial fibrillation. Consider the following lifestyle factors and how they may affect you.

  • Diet: Eat plenty of fresh fruits and vegetables and avoid fatty meats and too much processed food or ready-made food. This will help you keep your cholesterol levels in check. Reduce your salt intake to help get control of high blood pressure, another factor which can contribute to atrial fibrillation.
  • Exercise: Regular physical activity not only helps keep weight under control, but also helps you maintain a positive outlook on life. Consult your doctor/nurse or pharmacist before starting any new form of exercise or sport to ensure it is not dangerous in view of your health condition. Avoid martial arts and scuba diving.
  • Stress: Atrial fibrillation is more common in people who are stressed. Try to find a way to handle your stress and make exercise part of your daily routine.

ONLINE TIPS

Blodproppsskolan
www.blodproppsskolan.se

STROKE-riksförbundet
www.strokeforbundet.se

Hjärt- och Lungsjukas Riksförbund
www.hjart-lung.se

Anticoagulation Europe
www.anticoagulationeurope.org

Atrial Fibrillation Association
www.afa-international.org

1177 Vårdguiden
www.1177.se

Patientföreningen mot venös tromboemblism
www.blodproppar.se

Eliquis® belongs to a group of medicines called anticoagulants (blood thinners). This medicine helps to prevent blood clots from forming by blocking Factor Xa, which is an important component of blood clotting. The active substance of Eliquis® is called apixaban. Eliquis® is available as film-coated tablets in strengths of 2.5 and 5 mg. Eliquis® is used in adults: 1. To prevent blood clots (deep vein thrombosis, DVT) from forming after hip or knee surgery. 2. To prevent blood clots from forming in the heart in patients with an irregular heart beat (atrial fibrillation) and at least one additional risk factor. Blood clots may break off and travel to the brain and lead to a stroke or to other organs and prevent normal blood flow to that organ. 3. To treat blood clots in the veins of your legs (deep vein thrombosis) and in the blood vessels of your lungs (pulmonary embolism), and to prevent blood clots from re-occurring in the blood vessels of your legs and/or lungs. Do not take Eliquis® if: you are allergic to apixaban or any of the other ingredients of this medicine; you are bleeding excessively; you have a disease in an organ of the body that increases the risk of serious bleeding (such as an active or a recent ulcer of your stomach or bowel, recent bleeding in your brain); you have a liver disease which leads to increased risk of bleeding (hepatic coagulopathy); you are taking medicines to prevent blood clotting (e.g., warfarin, rivaroxaban, dabigatran or heparin), except when changing anticoagulant treatment or while having a venous or arterial lineand you get heparin through this line to keep it open; you have an artificial heart valve.

For full details on Eliquis®, carefully read the patient information leaflet included in the package (see also www.fass.se). This text is based on the patient information leaflet from November 2016.

Bristol-Myers Squibb AB, +46 (0)8-7047100, www.bms.se
Pfizer AB, +46 (0)8-550 52 000, www.pfizer.se

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