Anticoagulants and hormone replacement therapy

Here I am taking my eliquis and my estrogen thinking alls well with the world .........since I have seen my cardiologist and he certainly is aware of my drug list as is my EP who did my ablation.........saw my gynecologist yesterday who said "you can't be taking eliquis and estrogen. One makes your blood thicker (estrogen so more chance of clots) and the other makes it thinner!" She was very surprised my heart doctors had not said something. I will ask my cardiologist but wondered if any of you ladies have run into this? She then said well even if your cardiologist okay so it you still need off since you are over 60. Ugh......don't know bout any of you but my estrogen has been such a help in so many areas. Anybody out there share this issue? I know estrogen increase chances of blood clot but was hoping the eliquis trumped it.

37 Replies

  • Hi Eliza,

    I don't know anything first-hand about estrogen, but I'd like to ask about your taking Eliquis. Do you have active AF, or did your ablation knock it out? And how long has it been since the ablation?

    I ask because you may not need it. The CHADS-VASC criteria apply to people who are in AF. If you aren't having arrhythmias you don't fit in that rubric. You might want to check with your cardiologist about that.

  • Kodaska Many EPs now believe that successful ablation does NOT remove the stroke risk. The scar tissue in the atrium can allow clots to form even if you are not in AF just as water pipes ferr up due to impurities .

  • Hello....just wanted to say how supportive, informative and helpful I find your posts and replies.

    May I point out that water pipes do not furr up due to impurities....they furr up mostly due to a build up of calcium magnesium found in hard water.... commonly known as limescale.

    Over time it crystallises to a rock like formation which eventually blocks the pipes ....similar to atherosclerosis of the human arteries.

    Kind regards,

  • I do know all that thanks but was trying to use a shorthand . As an engineer I don't like to be too technical or people's eyes glaze over. Yes the limescale is an impurity. Pure H2O will not furr up pipes.

    In the heart, what happens is that the scar tissue and lesions form a rough surface which can encourage eddy currents to form which can allow clots as well. .

  • Well said, Bob. And I like the furring up analogy (at first I thought you meant rust, as in ferrous deposits). My comment combined what I've learned in this forum with a caution stemming from knowing that I don't really know what I'm talking about. Your comment makes me think I want to talk with a cardio about this, but not the one who insisted I take flecainide because "we like to make sure our patients are covered."

  • Yes bob correct. My EP and cardiologist are saying it is way too early to go off. My ablation was last September. I don't know exactly what "success" means. I'm much better and am in nsr, however I o get the occasional racing that may last a couple hours and little runs that last few seconds. Not sure I would be ready to go off EVEN IF they said to.

  • Wow I use an estrogen cream and also take apixaban have never been told not to use the cream bit worried now have to talk to GP

  • A gynecologist is probably not the best person to advise you about your anti-coagulation. When one uses simplistic (and erroneous) language such as 'thinning' and 'thickening' blood, simplistic myths can arise. Apixaban works by preventing your blood from clotting as quickly or as effectively as normal. It does this by blocking a substance in your blood which is involved in the development of blood clots, called factor Xa. In a separate context, it is also known that the ability of estrogen to block factor Xa can be significantly reduced among post-menopausal estrogen users. If the estrogen was 'undoing' the work of the apixaban, then that might constitute a problem. But it's not, it's simply 'not adding to it' in any way. I'm not a medic so for your peace of mind it is absolutely essential you confirm this with your cardiologist/EP - but if there were real problems - there being large numbers of women on both treatments - I'm sure we'd know about them by now.

  • Hi I've only had AF a year now ,I'm on HRT,have been for years,I also take Apixaban,with the knowledge of all Consultants! I think your Gynacologist is a bit confused!

    Also my Gynacologist said to stay on HRT as long as possible!

  • I was on HRT for 10 years. It was great as I had my ovaries removed. I had undiagnosed PAF for a few year s and then had a heart attack. The cardiologist told me to stop HRT straight away. So heart attack followed by hot flashes and lots more downsides of no HRT. Now I use a topical HRT pessery . My Gynaecologist is ok with this. Not as good as the old HRT though :-(

  • How horrible delphetta! Did you go off it gradually?

  • Can I ask how long you have been on the estrogen and your age range anne? My gynecologist wants me off REGARDLESS of the eliquis now because I'm 60. She was talking 2 separate being on both drugs and the other my age and being on estrogen. Estrogen has been such a help in feeling better in so many ways I have chosen to BLOCK all the bad rap it gets. I apologize in advance to all for talking lot about estrogen on afib forum but it all connects for me in that the doctors disagree and the drugs have the cost benefit and risks whether anticoagulants or estrogen or flecinide. It's all very distressing.

  • Hi Eliza1,I am just 70, I had an early menopause,so I can't remember exactly, 10 yrs ago I had an elective Hysterectomy,and my Gynacologist told me I could stay on the lowest possible dose,I take Elleste Solo ,1mg a day! As I've said before,I've relatives in USA who are in their 80`s and will not come off treatment,they have regular checks and their Dr`s are fine about it.

  • 'you still need off since you are over 60. Ugh......'

    Cheeky twerp - sounds like the type who calls you 'dear' too.

    I use HRT patches and take Apixaban without any comments from medics over the last 2 years and I am very over 60. One would expect that such an obvious connection would have been made by experts but it is something I will also get checked out.

  • Hi Finvola,my Gynacologist is very for HRT,he has worked in the States and very for HRT as long as it's a safe dose!

    I have relatives in the USA who are on their 80`s,no intention of coming off so as long as my male GP,and various specialists don't mind that's fine by me!

    They have checked all my meds(also my husband )who is medically qualified,as I also have Rheumatoid Disease,so it's a lot to get your head round! (I rattle ha ha )

  • Thank you for that Anne - it's all about quality of life versus some degree of risk and I know what you mean about rattling. I would stop my lowest dose HRT patches only after a major battle with my GP - lol.

  • YES!!

  • Interestingly my sister in law was taken off HRT at 65 I think as the doctor said there was more risk of cancer from staying on it at that age and older.

  • Yes, breast cancer risk is increased slightly but my GP and I did a risk/benefits talk and he agreed that it was probably better to remain on it - with regular screening.

  • Actually I was told by gynecologist last year that connection with breast cancer has not been proven. Seems like there two different medical schools of thought on this. Different studies, research, doctors.....makes your head spin!!!!

  • I am 71 and was taken off hrt 6 years ago. I was advised that HRT raises the risk of cancer as cancer tumours feed off the oestrogen. I could have carried on but did not think the risk worth taking as the manufacturers of this pessary recommended that the strength be halved after trials to see if there was an increased risk. I do not miss them now but do find dry skin and hair a problem, but this is easily remedied..

  • I was on Zoladex hormone implants for three years post prostate cancer surgery complete with hot flushes and body hair loss. Didn't grow boobs fortunately. This was to prevent testosterone production on which the cancer cells rely for growth. Complex things hormones.

  • Yup....depending who you talk to different with so many of these medical issues. Frustrating and distressing.

  • Hi Bob, 

    Don't know how I came to this post but did you or anyone come to an answer. I have had to go back on Zolatex and never gave it a thought of a possible bad mix with the Apixaban I am taking. By the way I am male and 75

  • I  was on Warfarin with no problems so I can't see why it should be any different but talk to your pharmacist.

  • I went to my GP and she said she did not want to give me Estrogen cream because It could affect my AF that was a few months ago. I only started Apixaban last week so

    I assumed it was to do with the AF and not the A/C maybe its both

  • Thank you for sharing this with the forum. I have been taking Premarin from my late fifties until last year and I'm eighty four now. My GP put me on estriol cream a few months ago as he said I needed it. Aches which had developed in my fingers stopped ( fingers crossed) and my nails are visibly stronger.

    Warfarin is my anticoagulant of choice as I can test this myself but I think it has has made my hair a lot thinner! I do hope you can get some more informed opinions and share them with us. Good luck, Terry

  • Hi Eliza,

    This is my favorite kind of question because Gynecology was my specialty before I retired....SO, here are my thoughts for what they are worth. Yes, the short answer is that estrogen does make one be more likely to have strokes or blood clots, so many cardiologists will strongly suggest that you decrease or stop the estrogen as soon as possible to decrease your risk. Being on anticoagulation is a very good thing, but of course, if you want to lessen your risk significantly more it is wise to stop the estrogen. When they say "you can't be on both" it is not like a terrible drug interaction, but it many ways it doesn't make sense to be ok with increasing your stroke risk while working so hard to decrease it.

    If you are on an estrogen patch, your risk is lower than if you take oral estrogen. If you are using something like Premarin vaginal cream or an Estring, that is not systemically absorbed, only locally so that is not increasing your risks.

    Being over 60 is probably a good time for most women to start to wean off the estrogen. The most important thing about this is doing it SLOWLY. Anyone who stops estrogen cold turkey will be miserable and say they can't do it. This is why I always had my patients decrease over several months. For instance, this week take 6 pills instead of 7, next week take 5, eventually get to every other day, then a couple per week. Anytime you feel like you are getting too many hot flashes then hold at that level for another week or so. If you are using a patch, start to change it after 5 days, instead of 3 or 4, and then 6 days and so on.

    Meanwhile make sure and do something like yoga and or mediation for stress management.

    Really it is just about trying to lower your risks in every way possible, but the decisions are up to you. You know how you feel and how you want to approach it. Your EP and cardiology people know little about estrogen except that they want you off of it. Your gynecologist knows little about the issues you face with AF. This is why you need to be your own advocate. I hope this helps a little.

  • Hi Eliza and srm grandma, hope you don't mind me jumping in here..

    I've just posted on here and was told to look back at this post. I'm peri menopausal, aged 49. I'm on sotalol & warfarin. Two GP's have said no to HRT (more because of the anticoagulant) and look at alternative options. Told me to check which I did under 'menopause' and it says in menopause the reduced oestrogen can increase the risk of stroke. Having AF I'm already at greater risk and this has worried me further. But reading your reply, is it better for me to have less oestrogen ? I'd be very grateful for your reply 😊

  • Back in the 80's and 90's everyone believed that estrogen was cardio protective. We put patients on it without concern because the evidence to that date seemed to point in that direction. But the WHI study was a giant study, well done, and showed that estrogen can increase stroke risk and not be protective of the heart is we started to prescribe for the least amount of estrogen for the shortest amount of time to help to alleviate symptoms of menopause.

    There are some non estrogen options for help with hot flashes such as Brisdelle (paroxatine) that might be helpful for you. Also, eating more fruits and vegetables, getting more exercise , and doing things like yoga and meditation help in stress management. Alcohol and caffeine can also trigger symptoms . (it all sounds a lot like what to do for A.F, right??)

    The bigger part of your concern is the stroke risk, of course and so one has to weigh the risks and benefits. If your doc is willing to put you on a very low dose of estrogen and you are anti coagulated, that may be a risk you are willing to accept for a short period of time. Also, vaginal estrogen does not increase your stroke risk, so some Estrace cream or an Estring are good options. On top of all of that, menopause is also a time when AF can be more symptomatic because of the fluctuations in estrogen within the body. Just what we need :-(

    My advice is to do everything you can to be as healthy as you can. Dress in layers to cool off when you need to, try to get good sleep and ask your doc about the paroxatine option for you. I hope that helps.

  • That's so helpful thankyou so much. Yes, all that I try todo with regards to my AF already. I'm going to write this all down and have a chat with my doctor. Thanks again 😊

  • Also disturbing that neither my cardiologist or EP who is renowned said anything about my taking estrogen. What the heck?!!!!

  • My view is that unfortunately the medical profession doesn't' appreciate have the training / doesn't have the time to look at and establish all the interactions between different medicines / different people's afflictions, etc and look at it holistically per person. This is not their fault per se but at medical school they do not cover this and then as they go through their career they specialise more and more and so their focus is on their speciality and often developing new techniques, equipment, etc.

    Obviously there are the known affects but as soon as it starts to be less common it becomes difficult until it is like looking for a needle in the haystack. In my view this is why in many cases those hospitals involved in training / pioneering / developing can provide additional benefits.

  • I agree that too few physicians take a holistic view, and the time constraints of the system don't allow for in depth visits to sort out the complex issues. Everyone needs to be his/her own best advocate to coordinate their care between the specialties. Also, we each need to take responsibility for exercise and eating right and not expect the medical profession to constantly fix us with a pill when we hold the key to our own health in so many instances.

  • Apologies but the reply I just typed under Eliza1 was meant to be in the general first level response!!!

  • It's true Peter. That's why many doctors in the states are now becoming concierge doctors.......doctors that limit the number of patients and are available 24 hours to their patients. What's the catch? A hefty yearly charge. Insurance still pays them for each visit. For some patients who can afford it it is money well spent. It certainly is piece of mind. That probably seems like not such a big deal to you all out in the U.K. Who I see often are paying for private services out of pocket when put on a waiting list for services.

  • It is believed that using HRT while on anticoagulants leads to the formation of blood clots. Blood clots usually form in the small veins near the surface of the skin and deep in the veins as well. This leads to a condition known as deep vein thrombosis and this can be painful. Sometimes the clots break from their original location and travels to the heart and lungs. If this happens it can become life threatening and Anticoagulants are advised in this case. Thus doctors are cautious to advise HRT along with anticoagulants.

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