Apixaban alternatives

Can anyone tell me a better alternative to Apixaban please? My mum is currently taking this med but I think this may be causing her stomach issues. Thank you

[Perrylees]

Hi

There are a few.... Rivaroxaban and dabigatran are two other NOACS that I have personally tried. It just so happens that apixaban suits me best but everybody is different. Rivaroxaban seems to be very popular and has the advantage of being a once a day dose. Perhaps your mum could ask to try one of these? Both work in the same way as apixaban. Dabigatran and rivaroxaban both made me feel nauseous but as I said everybody is different so it's definitely worth trying something else if her GP is willing.

Then of course there is good old Warfarin. My mum who is 83 now has been on it for 10 years and has had no problems at all. You do have to go for regular INR tests ( once your INR level is sorted out its usually once a month) and you do have to be a little bit careful with certain foods ( mainly leafy greens and cranberries I think) but there are LOADS of people on it.

Hope you get your mum sorted out!

Ruth

[Hidden in reply to Perrylees]

Perrylees, she is going to discuss the one a day dose NOACS with her GP as taking 2 Apixaban a day may be causing the problems. Thank you for your advice x

[meadfoot]

Hi Plainjane,

I don't know that any of the alternative anticoagulants are better but there are others to consider with your GP. I take Rivaoxaban, I also have a Hiatus Hernia and know that in my case my stomach and acid reflux issues are related to that condition rather than meds driven.

I have had no side effects with Rivaoxaban but then we are all different in our reactions. My friend takes Apixaban and has been fine with it. It's a matter of working together with your medics until the right combination is found.

I hope your mum sees an EP quickly and gets back on track very soon. I am sure they will sort out her issues and ease the situation for you all. It's a struggle at times but eventually things settle and are under control. Best wishes.

[BobD Volunteer]

Whilst I understand your concern it is important NOT to do anything in a knee jerk reaction. Check the paper instructions with the drug. Many require them to be take with a large glass of water. Some with some without food. Quite often such symptoms will subside after a few weeks once the body adjusts.

Anticoagulation is vital in your mother's case. Whatever else she may stop do NOT stop this drug until such time as medical advice has been sought and given.

[Hidden in reply to BobD]

Oh she won't stop taking this as she knows the importance.

[Finvola]

I have been taking Apixaban for two and a half years without problems of any kind but there are three other NOACs available - Dabigitran, Rivaroxaban and Edoxaban. For me, AF was always accompanied by dreadful gastric upsets but since the episodes have stopped by Flecainide, the gut troubles have also stopped.

There are very good fact sheets about anti coagulants available on the main AFA website but this morning the site seems to have problems and I couldn't access any of them. Gastric upsets are listed as possible side effects of NOACs for some people and it may be a matter of trial and error - and some pushing of that GP you referred to earlier.

I hope you can get your mum stabilised on her medication and free of stomach problems.

[Hidden in reply to Finvola]

Finvola, she isn't taking Flecainide but I have asked her to ask her GP about this. I don't even know what type of AF she has and neither does she. All I know is she doesn't have the jumping heart all the time. If it agrees with her and it is suitable I am sure the Flecainide would help as it is the AF symptoms that are disturbing her at present. Thank you x

[Finvola in reply to Hidden]

It sounds like your mum has paroxysmal AF which comes and goes and is miserable to put up with. GP's cannot prescribe Flecainide, which is an anti-arrhythmic drug and it must be first prescribed by a cardiologist who is able to assess its suitability for a particular patient.

If you haven't done so already, might it be an idea for a family member to accompany your mum to the GP? Two brains listening and asking questions are more powerful than one. At my last EP appointment the patient before me had his mum, dad and brother all troop in with him - and all came out smiling!!

Best wishes to your mum.

[Finvola in reply to Finvola]

PS - I have just re-read your first post and the best person to see is an Electrophysiologist who specialises in the electrics of the heart. Protocols vary from area to area but usually the referral to an EP is from a cardiologist. However if you can afford approx £200, a private consultation with a good EP could get things moving quickly. A GP can make a private referral at the patient's request.

[dedeottie]

I would give it a bit longer yet. I have recently been changed to apixaban from warfarin. Apixaban was chosen because I believe it has less chance of causing bleeding in the brain or stomach (or so I was told).

For about 3 weeks I felt slightly nauseous, bloated and some reflux. Gradually that all lessened and now I feel fine.

It depends of course on how severe the stomach problems are so it might be worth a chat with her G.P. x

[Bagrat in reply to dedeottie]

dedeottie can I ask how the swap from warfarin to apixaban was managed. I am gathering info re all NOACs with a view to seeing my GP about a swap and also ? re referral to cardio for reassessment of my flec dose as it does seem to wipe me out some days.

[dedeottie in reply to Bagrat]

Hi. It was panic measures actually. I had to have the vitimin k injection as there was a fear of bleeding following an ablation procedure. When my E.P. was reconsidering anticoagulation he said the vitimin k would stay in my system for a while so warfarin wouldnt work. I had to wait 72 hours then start apixaban. He said I would be covered by apixaban 90 minutes after taking it. Im sure your transition would be managed in a calmer way! I have really enjoyed being able to be more spontaneous with my diet. X

[CDreamer]

There is another new anticoagulant Edoxaban - I don't know much about it but reportedly is ok. Personally I would avoid Dabigatran as that does cause gastric probs in many people but as Bob says, first go through all the instructions and ensure they are followed carefully as this can make a huge difference. Drinking a FULL glass of water is very important to allow the drug to dissolve. Try taking it at slightly different times.

And as others have said, sometimes these side effects resolve themselves with time so leave it for 2-3 weeks - or it could be a reflexive reaction to the AF, in which case nothing much you can do. Whatever, it is, remember you can live with gastric problems, if your Mum survived a stroke, and many don't, that would be much harder to live with.

Best wishes CD

[ruskin10]

Hello Plainjane, I take Dabigatran and have stomach rumbles and digestion probs every day, but I can put up wth it. My husband takes Rivoraxaban and has no stomach probs.

[ruskin10]

PS I think it depends on the individual and their body

[Hidden]

Hi Ruskin10, thanks for your reply. I know people tolerate meds better than others and Mum has had a sensitive stomach for the last 12 years so I guess it's about finding one that suits.

[PeterWh in reply to Hidden]

With most of the meds it can take 4 weeks or so for the body to settle and stabilise. Obviously some people adjust more quickly. The Also with some dose adjustments can take the same. For instance my EP and GP have only ever done 1.25mg at a time. So I started on 1.25mg then 2 to 3 weeks later increased to 2.5mg. Max dose was 7.5mg and currently 5mg but dropped in 1.25mg steps about a month apart.

[Annekw]

Hi I have been on Apixaban 15months now no problems,although I do take a stomach protector Pantoprozil,as I also take non-steroidals as I also have Rheumatoid Disease! As your mother has a sensitive stomach,this maybe the route to follow!

[guitarman49]

Hi Sorry to hear about your Mum. I was taking Apixaban for 2 yrs until 3 weeks ago when I discussed my abdominal pain issues which had been severe for almost a year with my EP even though I had many tests/scans to determine the cause , all were negative. Without question he said it was probably Apixaban and change me onto Rivaroxaban. Within 24 hrs no pain and I have been abdominal pain free for the past 3 weeks. Hopefully it will continue. I know we are all different but for sure we need to be anti coagulated. Good luck with your EP.

[Hidden in reply to guitarman49]

Hi guitarman, thanks for your reply, did the abdominal pains also make your heart race? I will encourage my Mum to ask for a substitute for the Apixaban.

[guitarman49]

Hi Sorry for the late reply. Although I have PAF and SA node heart block my pulse rarely goes above 75 bpm , it's more likely to go downwards whether or not I have the abdominal pains. Certainly vagal tone does have an effect on my heart. I'm now on the waiting list at the Freeman Newcastle for a PVI ablation. My EP is fairly certain this is the reason for my PAF , interestingly he thinks the drugs (Flec & Bisopropol ) are causing the heart block. So if the ablation is successful then 2 problems are taken care of and I come off the drugs except Rivaroxaban.

I'm sure your EP will cover all aspects of your Mum's problem. Good luck.

[Hidden in reply to guitarman49]

Thank you so much, I do hope so x

[gordeno8]

With apixaban which is what take daily.you should also have lansoprazole from your doctor..same thing happened to me 7 years ago.its acid reflux caused by the tablets

[gordeno8]

Apixaban is ok.just need to get lansoprazole,that will clear acid reflux problems.i had same trouble 7years ago when I started on them.no more problems now.