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Anti coagulants

Sorry everyone I have asked this question many times before, but haven’t actually received an answer. I do appreciate that it is an opinion and not medical advice, but would be grateful all the same.

I reside in England so as many on this forum are from different counties, I’m not sure whether other countries have the same rule..

Anyway in your opinion which do you thinking’s the best anti coagulant please?

I was on riveroxaban, but found that I either had a uti or as I have only one working kidney my gp wondered (although you couldn’t see it with the naked eye) if it was having a little bleed and if it was that causing it. He wants to change me to edoxaban, but a new registrar at the hospital suggested Apixaban. I believe there is another one, but off hand I can’t remember the name.

Help please as I do feel a bit anxious. Needless to say I have looked online, but I haven’t found that much help.

Thank you and sorry this is a bit long winded. Best wishes xxx

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I think the ones you talk about are what are known as NOAC's. I do not use them, my preferred A/c is Warfarin, however, this does not suit everyone for a shedload of wide ranging reasons. On the other hand these NOAC's all have advantages and disadvantages. I do suggest you start your own research. If you do a Google search and type in NOAC'S you should get a list of Meds which are in this group. You could always go to the AFA website and look through their resource material too.

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Thank you. I will do that

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Hello tapanac - there have been a few reports of patients being changed to Edoxaban and some suggestion that it is cheaper than the others. Like many drugs, the best one for you is the one which suits you - not terribly helpful, I know but much of drug therapy is trial and error.

I have been taking Apixaban for 5 years and have no problems with it whatsoever. If you go to the main AFA website and look under patient resources you will find explanations of the four newer anticoagulants - the fourth one being Dabigatran. I hope you find either of the two suggested to be more suitable for you.

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I wonder, do all the NOACs require an annual check for kidney function?

Dabigatran ( Pradaxa ) certainly does. Interestingly it is the one that Dr Gupta recommends in one of his videos.

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Apixaban does too - this year my surgery has changed from yearly blood tests to six monthly.

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Thank you

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Thank you. Again I will do that

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Have you experianced your hair thinning and/or hair loss while on it??

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I think I shed more individual hairs than I have ever done. Whether this is from ageing or Apixaban, I’m not sure - probably both, as other members have posted about hair thinning on anticoagulants.

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I am surprised I don't hear more comments about hair loss with noacs and warfarin! I take hair,skin and nails and am starting to see some improvement! Don't know if o.j. t conflicts with blood thinners though. Haven't been able to find any info On that.

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I don’t think there is a “best” anticoagulant. They are all different and what works well for one person won’t necessarily be the best choice for the next person. It can be trial and error. I was on Rivaroxiban but my EP switched me to Apixaban after a clot was discovered pre-ablation (I was off them for 48 hours before the procedure and the clot may have formed them). I was put on Apixaban but had a bad reaction so was then switched to Pradaxa for a few weeks but because of oesophagus inflammation that was unsuitable too so I’m now back on Rivaroxiban,

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Thank you

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What was your bad reaction to apixaban??

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I had Apixaban twice - once after a cardioversion for 4 weeks. A few days after the cardioversion I was diagnosed with Shingles. I had pains in my chest and back, headaches, unstable blood pressure and was icy cold. I thought this was all related to the Shingles and didn’t give the Apixaban a second thought but 3 days after the ablation attempt where they discovered the blood clot, I was changed to Apixaban I had similar symptoms. I also had post menopausal bleeding. I was readmitted to hospital (EP didn’t want me at home with a blood clot in my heart and unstable BP) and my anticoagulant was changed again.

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The only "best" is what suits you the best. They all work at what they are supposed to do. One may need to try all four plus warfarin to find out which suits you as we are all different.

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Thank you Bob

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I have been on Apixaban for several years with no problems whatsoever. The fact that it is taken twice a day means that it’s easier to get out of your system if necessary. I have a full blood picture taken once a year, but when I first started on it, my blood test was done after the first three months to make sure there were no adverse affects.

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Thank you

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What BobD says about which one is "best" is absolutely right (in my view) since everybody is different. In case it may help in your circumstances ….. I have Chronic Kidney Disease, stage 3 and have been taking Apixaban for the last couple of years without any problems I am aware of. I have a blood test every 6 months and the results have all been 'satisfactory' so far. In your own case I think you need to ask a qualified doctor which of the anticoagulants might be the most suitable for you given that only s/he will know your individual circumstances.

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Thank you. I did ask my GP and he said to change to Edoxaban and the Registrar at the hospital said Apixaban

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Then maybe you need to speak to someone higher up the medical 'food chain' …. a cardiologist or an electrophysiologist. Or perhaps you could ask your GP precisely WHY he was recommending Edoxaban? Was he taking all your medical history into account and then thinking that Edoxaban is best for you, or is prescribing Edoxaban the 'anti-coagulant of choice' within his practice. None of us here is competent to offer any advice; all we can do is relate our personal experiences.

I do hope you find the answer you are looking for.

Edited to say …. do watch Dr Gupta's video for which doodle68 has provided the link in the message 2 below this one. I don't think you'll find a better evaluation of the new anti-coagulants than that and hopefully it will help you decide. Watch the video all the way through to the end as I can think I can see why your GP was probably recommending Edoxaban for you.

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Hospital doc was probably thinking that Apixaban is available at both 5mg and 2.5mg dose. Normal dose is 5mg x 2 daily, but lower dose recommended for elderly over 75, those with weight less than 60kg or those with kidney problems who don’t tolerate the higher dose. Guess they might try higher dose with regular monitoring and reduce if necessary.

Suggest you download the patient info leaflet from t’internet and take it with you to GP for discussion.

Only saying..... not a medic. All the best.

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As always, I agree with BobD, the only one I could take is Edoxaban,

I tried all the other NOACS but they did not suit ME

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Hello Tapanac :-) see the video below....

I take Apixaban, a decision I made after doing a lot of research into anticoagulants.

My son who had a DVT requiring an anticoagulant saw a consultant privately and he asked which one the consultant would take and he replied Apixaban.

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Thank you very much for the video. That was so informative, but I’m still confused. My gp has given me the higher dose of edoxaban and taken me off rivaroxaban, but dr Gupta said that wasn’t good for renal disfunction and I only have one working kidney. Decisions decisions, eh. Thank you

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Just because you have only one kidney dosen't mean you have renal disfunction. If you have one that's working well that is sufficient. I have one, working well, and been on Apixaban for a couple of years with no problems.

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Oh ok thank you baba. That reassures me

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Thanks for posting this doodle, I found it very informative. It's also confirmed that I'm on the correct NOAC for me ... Apixaban. It's also reassuring to hear that the bleeding risks of this are no greater than those of aspirin.

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hi tapanac

I was put on apixaban gave me a side effect,bad Headache's now on a drug called pradaxa, with a poor kidney function i have it works quite well

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The latest research actually shows that warfarin with self management is superior to the NOACs:

ncbi.nlm.nih.gov/pubmed/303...

Patients on warfarin who self managed had a third of the strokes compared with the NOACs. Self management means monitoring your INR with a Coaguchek and adjusting your dose correspondingly. I find this easy to do, it takes a couple of minutes a week and I feel I'm in charge of my anticoagulation rather than vice versa. It's not possible to do this with the NOACs.

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I agree with you Mark I am on Warfarin and use a Coagucheck this way. Where I live though my surgery is within a catchment area of a hospital anticoagulation clinic so i still have to have blood tests as they will not accept my readings! I find it gives me piece of mind as i only am tested every ten weeks and i know my INR goes up and down.

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I was just looking in the news section for AF as I do regularly and saw this published today. It is more encouraging for NOAC takers ...:-)

''Interventions for Preventing Thromboembolic Events in Patients With Atrial Fibrillation: A Systematic Review ''

annals.org/aim/fullarticle/...

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It depends on what you're comparing NOACs with. In the trial you mention, NOACs are compared against people on warfarin without any assistance from modern monitoring. So one of the trials they use is Rocket where the Time in Therapeutic Range for warfarin users is a very poor 55%.

The trial I mention uses a self-monitoring device which enables much better control of warfarin. That is why the results are so much better.

Despite what the drug manufacturers say, a monitoring device for NOACs would improve their performance. Unfortunately such a device is not available.

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I was on Warfarin for nth on 20 years and never had a problem, swopped to Pradaxa (Dabitran I think is the name) about a year ago and so far OK on that too, apparently Warfarin is not as effective against brain bleeds/strokes and I was having a few TIA's hence the change over.

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Hi I was on Apixaban but had lots of headaches so i have changed to Edoxaban which is much better. My cardiologist feels it is the best one of the DOAC, and his words were "a very good drug!"

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Again the first I have heard of this drug? Has it been out there or is it new??

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Known in the US as Savaysa apparently and approved by the FDA 2015

daiichisankyo.com/media_inv...

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Also found this which says Edoxaban is not approved for use in the US if creatinine clearance is greater than 95 ml/min which I believe means good function of the kidneys. See conclusion on page1022

amjmed.com/article/S0002-93...

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I tried Apixaban and had bad reaction,bad back pain and UTI also exactly the same with Rivaroxaban felt so bad would not try any othe NOAC but went onto Warfarin and no bad side effects., bit of a faff having to be checked but I would rather do that than experience the side effects of NOACs

But as you can see by the replies it is trial and error, what suits one is not necessarily good for someone else. Good luck. Jo

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i am on Warfarin and because I got it in range quickly I only have to test every 2 months.

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Hi I live in England .

After being on 3 other Anti coagulants which gave me side effects. I was put on Apixaban which I have to take for the rest of my .life . I had a unprovoked blood clot in my right lung 9 months ago .Since taking Apixaban I feel great and no side effects whats so ever .

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I am in USA and am on Apixaban (Eliquis). Been on since late December of last year. My cardiologist told me there is an antidote for Apixaban should it be needed for a bleed. Being female with afib and high blood pressure seems like I wil be on the rest of my life I do have an appoint with ep in nyc in November to have him review my case.

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I would be very interested to see what your EP says about anticoagulants as I have just returned from seeing a registrar at St. George’s and despite saying about possible uti’s (which urine tests say no infection) and bleeding she decided to keep me on rivaroxaban rather than change to Apixaban which gp recommended for my brain tumour surgery which I had and one kidney and see what you say. Thankyou and good luck with your visit to consultant

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I will. My appointment in 11/30. Looking for answers. Stay well.

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And you

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As a vegetarian, I've asked my GP several times about coming off Warfarin and always get the same answer, that it's the only blood-thinner where in the case of a major bleed, there is an antidote back-up of K2 injections that none of the others has. I seem to remember reading somewhere that with one of the new ones there is now such a thing in place, can anyone enlighten me? And as there are no INR checks involved with the new drugs, how does one know it's working? Any advice would be very much appreciated!

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My own experience with anti coagulant:

Intially I tried xarelto but because all my AFib episode were happing early in the morning my Ep put me on Edoxaban to avoid the GIT bleeding!

few months later I did a brain MRI for exertional headches they suspected small bleeding so I stopped it and I read on line that Edoxaban has more risk for brain bleeding while xarelto has more risk for gastroentestinal b

so went bk to xarelto

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I was also on Rivaroxaban for a few months and I had bleeding from the bladder. It happened a number of times and I had two cystoscopies which showed bleeding from the bladder wall. The doctor changed my prescription to Apixaban and I have had no problems since (touch wood).

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Hi Tapanac,

I have been on a NOAC called Brilinta (Ticagrelor) 90Mg twice a day.

I reside in Canada,and it is fairly expensive but it is covered by our Health Ins plan.

Brilinta works well.I have no major side effects except some bruising if I am not careful .

Another good NOAC is Apixaban (eloquest).

I would highly recommend Brilinta.

Wishing you well.

Please let us know if you require any further help or info.

Enjoy your day.

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Thank you

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I am in the US, and my EP recommended Eliquis (apixaban), or Xaralto (Rivaroxaban). I chose Apixaban,due to the lesser bleeding risk, and have been on it for 5 months, with no problems. If you are not in the US, the price may not be an issue, but Apixaban is a lot more expensive than Rivoraxaban. That is the reason the EP also recommended Rivoraxaban. But the bottom line is what everyone else here has said, the best one is the one that is best for you.

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Go for Apixaban , I have been on it for 2 years now and no side effects, and not having to have your regulat trips to the anti coag clinic.

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Sorry I cant help as I am on warfarin because I also have an anuerysm so need a quick antidote if it were to rupture. I dont believe anyone can advise as to what the best one is because we are all so different. Meds affect us all in different ways. Im quite happy with warfarin as I am in correct INR range all of the time. Some people struggle with their food on it. I tend to eat whatever I want within reason and also I have a drink when I feel like it. So I think the best opyion for you is to go with whatever your doc thinks and then change if it doesnt suit you.

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