Changing from Aspirin to Apixaban

[Jenbo6]

I have been taking 300mg Aspirin for about two years after getting paroxymal tachycardia which developed into PAF. At my last visit to my EP he said we'd discuss changing to an anticoagulant at my next appointment in December. After reading so many things about Aspirin not being effective I am seeing my GP next week to ask to change to Apixaban - not keen on Warfarin. However, I have read that it can be quite dangerous to come off long term use of Aspirin (I sometimes wonder if I'm reading too much!) as after ten days,clots can form. Does anyone know if this is a known danger or would the Apixaban counteract that. I am presuming however that my GP will not try to make me go onto warfarin - I have all the cost / benefit info from your posts to support my case!! Perhaps I worry too much but reading everyone's posts daily I know I'm not alone.

[BobD Volunteer]

Good luck with your GP and do be prepared to fight. Some CCGs seem to put a blanket ban on NOACs due to costs considerations. Warfarin is no bad thing anyway and millions of people are on it globally . It only becomes a problem if you are one of those few people who find it hard to maintain a stable INR and for those yes we have the NOACs. There are arguments both sides mind you.

Bob

[Jenbo6 in reply to BobD]

Thanks Bob. Apart from giving me a sore stomach I can't think of any benefit from the huge dose of Aspirin. Prepared to fight !

[rosyG]

Jenbo6 I am guessing here but it seems logical to think one would only get clots after coming off Asprin if one wasn't then taking an anti-coagulent so I wouldn't worry about switching- more to worry about if you just stay on Asprin

NICE has said NOACs should be considered if patients want to have them and some studies show they are, at times, safer. I like the fact that I can check I am in range with warfarin but if NOACs continue to look safer we might all be switched eventually !!

[realdon in reply to rosyG]

I don't think it is correct to say that NICE has said that NOACs should be considered merely if patients want to have them. What the new clinical guidelines in NICE guidelines 180 say is that anticoagulation should be CONSIDERED for men with a CHA2DS2-VASc score of 1, and should be OFFERED to men with a score of 2 or above (mutatis mutandis for women). The guidance then goes on to say that anticoagulation may be with apixaban, dabigatran, rivaroxaban or "a vitamin K antagonist" (e.g. warfarin); but it then sets out the criteria for recommending the NOACs as an option. These are only recommended in the guidance for people with extra risk factors such as prior stroke, age 75 or older, hypertension. diabetes and symptomatic heart failure.

In my case my GP has said that in view of these guidelines she does not feel able to offer me a NOAC because I don't have any of the conditions that would qualify under the NICE recommendation. When I asked if this was on grounds of cost she strongly denied it. She has referred me back to the EPs at the arrythmia clinic and I shall see what they say on the 24th.

[Mrspat in reply to realdon]

I suspect that the extra risk factors criteria are being widely ignored. Although I have an underlying heart condition, it does not fall within the criteria given. My GP queried the recommendation of transferring from aspirin to Rivaroxaban or Apixaban but agreed to prescribe after checking with the cardiologist and being aware that I would refuse to return to warfarin.

[rosyG in reply to realdon]

Realdon I think it depends on how you interpret this page and I think you should take it up with your GP if you would prefer NOACs.

At the top of the page it includes ALL the options. Point 1.5.4 says DISCUSS THE OPTIONS FOR ANTI_COAGULATION and.. and BASE THE CHOICE ON THEIR CLINICALFeatures AND THEIR PREFERENCES this is a new guideline so maybe your GP is not aware?

I think it brings in the the risk factors here because it is thinking of the factors that are looked at for the CHADS VASC score , relating these to the NOACs

[realdon in reply to rosyG]

Not sure that the points you refer to help very much because it still seems clear that the RECOMMENDATION for NOACs is only in the cases mentioned. True it is that there is reference to patient preference but I suspect that the preference is limited to choice within the recommendations, otherwise the text could be much shorter. Having said that, I will certainly be taking this up with the EP next week.

My GP is not herself an expert, but they had had a "teach in" on the new guidelines (not sure from whom) so she was not just taking a view herself.

[rosyG in reply to realdon]

quite likely the teach in was from someone thinking of the cost- keep pressing if that's what you want!

[Hidden]

I'd have thought slowly reduce your dose of aspirin and then make the change, but I'm just guessing. I changed from aspirin to warfarin overnight, but I was only taking 75mg aspirin once or twice a day. I got blood in my pee even at that dose of aspirin when I started, glad to be off it to be honest.

Koll

[Jenbo6]

Thanks everyone. Appointment should go well! I just don't like the idea of warfarin but was concerned about suddenly stopping my aspirin.

[Beta44]

I switched from Aspirin to Apixaban a few months ago and was told to just stop the Aspirin and start the Apixaban. That's what I did with no problems. I like Apixaban seem to bruise less easily and have no side effects.

[Chicohamilton in reply to Beta44]

Hi - I’m on aspirin 75mg but I’m feeling slightly concerned by my own reluctance to switch to Apixaban - I’ve have had 2 self converting AF episodes in the past 12 months - but I’ve been in normal rhythm for 6 months now and I’m feeling very stable. I’ve just come from EP visit and he recommends i go on apixaban on my 65th Birthday next April as a general stroke prevention

[Beta44 in reply to Chicohamilton]

Aspirin is no longer recommended for stroke prevention in AF and at 65 you should be having anticoagulation. Unless you prefer Warfarin then Apixaban is probably the best of the rest. I would follow the EP advice.

[Chicohamilton in reply to Beta44]

Thanks for reply - I think you are correct 👍🏻

[Jenbo6]

Thank youBeta44. I think I worry too much but feel reassured by the responses to my question. All I have to do now is convince my GP that Apixaban is for me!

[rosyG]

One doctor on our CCG told me the NOACs are not more expensive if one takes out the cost of testing clinics so I don't think they will be excluded on cost grounds for long