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Should I stop Eliquis?

I'm really wondering about switching back to warfarin. There is no approved antidote for Eliquis if one happened to be in an accident. Maybe hospitals do have a special unapproved treatment, I don't know. Eliquis is very convenient but is it worth it? Warfarin you can counteract with Vit K. I am wearing my warfarin Medic Alert bracelet but just found out it would be useless if I needed treatment for a bleed, because Vit K doesn't work for warfarin.

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It has never worried me at all but we are all different and I was never on Wafarin as I refused it originally as we travelled a lot and I couldn’t see how I could cope with Wafarin, of course I didn’t know about self-testing machines then.

The chances of having a severe, life threatening bleed is so low that I wouldn’t consider it a threat and the doctors I talked to all said that overall the bleed risk for DOACs, especially a brain bleed, is less and the half life 12 hours that it is not a concern.

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You can get an Apixaban wristband from Amazon.

amazon.co.uk/APIXABAN-medic...

There are others as well. I changed from Warfarin to Apixaban and was worried about what you describe. But others on here explained why I shouldn't be so concerned, so hopefully will do the same soon for you to read.

But my big reason to change was that my EP said Apixaban had the lowest risk of a cranial bleed and that was my main concern, and still is.

Koll

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I take a different NOAC called Pradaxa (dabigatran). It does have an antidote called Praxbind. BUT were I to have an emargency, what are the chances of there being Praxbind to hand?

I'm sure that you wouldn't be left to bleed to death and by taking 2 tablets daily there is a very short time effect.

The convenience of a NOAC is priceless to me.

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Me too! (I've always wanted to say that in a post....)

Adrian

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I have a bleed risk from haemangioma in my mouth. I was told many years ago that I could bleed to death if I bit my tongue in an acciden but I came off a scooter at 60 mph without a bleed. I now take Pradaxa as the risk of a second full stroke is higher than the bleed risk. Having escaped the Grim Reaper a few times I'll take my chances that the nearest hospital has Praxbind. In the fullness of time Boehringer Ingelheim may place on public release the video where I am weilding a rip saw and razor sharp bill hook.

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A serious accident will be a threatening issue whether one takes Warfarin or one of the new anticoagulants (NOAC's/DOAC's) and time will be of the essence in stabilising vital functions. This, to me, means that emergency treatment of life threatening bleeding will not depend on a reversal agent being available at all and it is therefore a bit of a red herring, but on tried and tested methods using plasma etc.

Remember that anticoagulants only slow the rate of coagulation - they don't stop it completely and a bleed doesn't mean the worst - they do stop. It's good that you realised the danger of wearing a Warfarin band when you take Apixaban.

I take Apixaban and bought a Talisman bracelet from the IDBand company. You have to decide what works best for you both physically and mentally. I like the convenience of Apixaban - one blood test annually, done by a nurse and two tablets daily. I was prescribed Apixaban 4 years ago by a cardiologist who said it had the lowest bleed risk of any.

Best wishes with your decision.

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I agree with CDreamer and Koll.

My EP advised that the cranial bleed risk with Apixoban is less than others including Warfarin.

I have had no problems having been on Apixoban for almost 18 months. I travelled over Rajastan last year and am about to go on holiday, again to India.

I loathe having to take any pills but the risk of stroke is too great not to.

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Perhaps you might find the following reassuring?

From the NICE website: cks.nice.org.uk/anticoagula...

"Risk of bleeding

Bleeding is a well-recognized adverse effect of all anticoagulants. However, one large randomized controlled trial (RCT) (n = 18,201) that compared the efficacy of apixaban with warfarin in people with atrial fibrillation (at an increased risk of stroke) found that [Granger et al, 2011]:_c2a0_0.001.

Major bleeding — there was a lower risk in people taking apixaban (2.13% per year) compared with warfarin (3.09% per year).

Non-major bleeding — there was a lower risk in people taking apixaban (4.07% per year) compared with warfarin (6.01% per year).

Intracranial bleeding — rates were significantly lower with apixaban (0.33% per year) compared with warfarin (0.80% per year).

Gastrointestinal (GI) bleeding — there was no significant difference between apixaban (0.76% per year) and warfarin (0.86% per year)."

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Unfortunately, that trial (Aristotle) had a relatively poor time in therapeutic range for warfarin (mean 62%). The safety of warfarin doubles with reasonable control (70%) where it's similar to the NOACs. Once above 80% (achievable with a Coaguchek) warfarin is actually superior to the NOACs.

Of course the trials were sponsored by the manufacturer, so they would want a positive result!

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I clearly didn't dig deep enough to determine the source of the extract I posted. I have since checked and you are right about the funding. I apologise if I have posted unreliable information. However, since it came from the NICE website I considered it trustworthy and to be honest I'm not entirely convinced that trials sponsored by a pharma manufacturer are necessarily biased.

I notice that no source is given for the figures you quote.

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I agree it's not necessarily wrong if it's sponsored by the manufacturer - as almost all trials on new drugs are. It's a factor to be aware of, you don't spend £M100's without being pretty sure you can get the right answer. None of the NOAC trials were against well managed warfarin.

The 62% figure came from a presentation entitled "State of the art in factor Xa inhibition", the 70% from:

ncbi.nlm.nih.gov/pubmed/274...

the 80% from:

ncbi.nlm.nih.gov/pubmed/283... and

medscape.com/viewarticle/87...

ncbi.nlm.nih.gov/pubmed/263...

plus other papers I've gathered over the time.

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Thank you for quoting your sources. I take your point about apixaban not being judged against well-managed warfarin in the trial I mentioned.

I guess I'm a bit out of my depth when it comes to evaluating scientific/medical studies. I'm an arts/humanities person and much more used to, and confident in, evaluating research in (some of) those areas.

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read the conclusions in the abstracts. the graphs and stats are confusing. but the summary gives you guidance. and the Medscape articles include disclosures about the researchers' possible biases.

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I agree wth CD and Koll - I am on Rivaroxaban. My father was on warfarin, he must have had over 8 visits to A & E for severe nose bleeds, and bad bleeds gashes on arms and legs from falls. Not once was he given the vit K antedote, they just kept him in until all was under contol, quite a few of these times he was there for more than 24 hours.

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Thank you all very much for taking the time to share your thoughts. I think I'll keep the Eliquis and just get a new bracelet. I am not currently noticing any increased risk of bleeding. I even fell and had a bad scalp wound and it didn't bleed that much.

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I've actually found I bruise more easily on apixaban than when I was on warfarin, and that if I cut myself it takes far longer to clot. But after years of stability my INR started going all over the place and I felt an NOAC was the only way to not be tied to the clinic weekly.

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Yes I had trouble maintaining consistency in my diet, since we eat out of our garden.

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Hi All many thanks for all your input

Has anyone noticed any dark discolouration on lower legs and feet

when using Rivaroxaban or Apixaban?

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I do have dark discolouration of my lower legs particularly but am not taking either of those. It could be the result of something else related to the heart. I've not bothered to check with my GP yet.

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Hi Barney

Yes I have some dark patches mainly on my left leg - look like bruises, these have appeared since I have been taking Rivaroxaban. I did ask my GP, she had a look and just said they were nothing to do with veins and said no more, dismissed it. I sometimes get a mottled bluish rash on my feet, been told that is because I have some fliud on my feet and ankles - not much but it is there. When my father was on warafin he was covered with bruises or blue patches. The last few months of his life he was taken off warafin and with a month they had all disappeared.

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Hi cassie...many thanks for your reply

I was on rivaroxaban for over a year then recently my legs showed a really bad rash of blue black red patches.

I stopped the rivaroxaban an within a few days rash disappeared and even my hair started to thicken up.

I was advised to come off it and now i am on Apixaban so far ok although i still have a few black patches on lower legs.

I was off any sort of blood thinner for over a week and resumed obviously because of A.F..wish i could come off it all ....Oh well...

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Reading these replies reminds me of a comparison among bad experiences. The drug companies have done a good job of huckstering. Without assessing the scale of stroke risk, a knee jerk reaction to commencement of anti-coagulant therapy may be misplaced. Comparing the "best among the worst" is an exercise in futility. If one's profile leads to a conclusion that anti-coagulant therapy is indicated, then so be it. And one will have to juggle the consequences. No stroke is better than a significant possibility of suffering a life threatening neurological event.

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the only thing we can do here is tell you our experiences. the best information will come from your doctor, a pharmacist, and online research of medical journals. I researched for over a year via medscape.com. check it out. i decided to take Eliquis -- apixaban -- for the reasons people have mentioned. BUT: i had gastric bypass surgery 2 decades ago. this affects absorption of all medications. NOBODY KNOWS how well apixaban absorbs after this surgery. the trials excluded people who had intestinal surgery. i found articles from medical professionals complaining about the lack of information for subgroups such as intestinal surgery and obese patients. there are no tests that can determine if the dosage recommended for Eliquis is appropriate for these subgroups. So while i took it for one month, and had blood tests, i never could be sure i was protected. Even the pharmacist said the only way they know Eliquis works is when someone goes off it, and they have a stroke. And as of now, there is no trial planned which will address the issues of absorption of Eliquis in subgroups not included in the trials. I switched to Warfarin because the INR can be tested and the dosage adjusted. I think warfarin is overkill -- it seems to stop all vitamin k in that coagulation chain -- and primitive. BUT at least i know it is being absorbed in my system, With Eliquis ... i had no idea. And no symptoms of 'thinner' blood during that month i took it. if i could i would take Eliquis, in spite of the high cost in the US. But for situations like mine, Warfarin is advised. Your milaegage may vary -- please do some research and consult medical professionals.

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I take Apixiban and are due a coronary angiogram in early December. My cardio has said due to a residual clot in my heart this will have to be done with the anticogulant on board. So I hope they know what they are doing.

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Hi I take Apixaban and have done for six years. I don't have any concerns . The effect of Apixaban only last for twelve hours which is why you have to take two doses to get 24hr cover, so a bleed will only last a short time. I believe this drug to be better and as good as if not better at preventing a stroke. There are less restrictions eg diet than Warfarin and no continual blood monitoring. Please research it before changing.

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Thank you Florence!

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