Apixaban versus Riveroxaban

I have just been prescribed Apixaban by St Barts; formerly I was to have taken Xarelto (Riveroxaban). I was told it was a bit less likely to cause a subconjunctival haemorrhage which I was worried about. Does anyone know anything about the merits and demerits of Apixaban?

[Tikaneko]

I am on Apixaban, apparently the doc says that has the least side effects!!!!! I struggled with its of side effects until the dose was lowered. All seems to well at present

[Hidden in reply to Tikaneko]

Thanks for your reply. My dose will be 2x5mg when I start; I don’t have know if that is a high/low dose. What were the side effects you experienced if you don’t mind my asking?

[Tikaneko in reply to Hidden]

I don’t mind at all. I was on 1 x 5mg twice daily, now I am on 2.5 twice daily. I have a bleeding nose (regularly), the doc has cauterised but it continues, headaches and aching joints. Tired and bloating. I also feel it affects my BP but doc says it isn’t that. On saying all this generally it is a good one and people take it for years with no affects at all. Some of us are not so lucky. Good luck

[Hidden in reply to Tikaneko]

Thanks. I will ask if I can take 1x 5mg - if 1 is enough, I am not sure why they have prescribed two.

[Tikaneko in reply to Hidden]

You have to take1x 2. 5 twice a day not 1 x 5mg daily

[Hidden in reply to Tikaneko]

Ok thanks

[rosyG]

I've taken it for a few years now. At AC conferences I've asked speakers which they would take and all said Apixaban- this was before Edoxaban came out!! I think there is less bleeding from ICH with Apixaban but of course the demographics of all trials were slightly different

[Hidden in reply to rosyG]

Thanks. Do you know what the advantages of Edoxaban are? I have heard that one of the NOACs is more expensive than the others but I don’t know which one or why.

[BobD Volunteer in reply to Hidden]

Special price I think. Lots of CCGs seem to be swapping.

[DK81 in reply to BobD]

I regret that I do understand your comment. What does "Special price" mean in this context? Also, CCG is not on the list of Abbreviations and Acronyms.

[BobD Volunteer in reply to DK81]

CCG =Clinical Commisioning Group. Local organisation who decide what drugs may be prescribed here in UK under NHS. Special price. I understand that Edoxaban has been heavily pushed and discounted but this is only hearsay for me.

[doodle68]

Hi Sam I have been on Apixaban for a couple of years and have found no discernable problems.

My son had a DVT and saw a consultant privately who prescribed anticoagulation and when asked which was the best recommended Apixaban .

[Hidden in reply to doodle68]

Thanks for your reply.

[Buffafly]

I was prescribed Rivaroxaban by my cardiologist. Later I had a bad fall and injured my cheekbone amongst other things. It never seemed to heal up, intermittent aching and swelling and a dark mark under the skin. Then I changed to Apixaban and the problem went, never to return. So I'm a fan. No side effects I can definitely blame on it.

[Hidden]

Sounds encouraging. Inwsntood it wa a bit less inclined to cause bleeding than the others.

[Sfhmgusa]

I am on my third week of Apixoban ( 2 x 5 Mg a day) I was in a dilemma before I started and dithered. On one hand wanted the protection of an anticoagulant but on the other worried about side effects and quality of life effects. I wish i had not worried. I feel great, no discernible negatives. I continue to wet shave, to work in the garden and get the odd scratch / nick and do all I always did as a moderately active 59 yr old . And it is fine. Tiny skin damages do bleed more than before but not excessively and it is in a way reassuring.

I have only ever taken ( bp meds) in the morning so an afternoon pill takes a bit of remembering. But I would say that the reputation for low/ no side effects of this drug has been borne out ... so far for me . Good luck hope you get the same

S

[Hidden in reply to Sfhmgusa]

Thanks very much for this reassuring reply.

[Deacon-L]

Hi, I was on Edoxiban and found it left me feeling horribly tired. 2 months ago, I was changed to Apixaban and have noticeable side effects at all.

[Brad43]

I've been taking apixaban for a few years 2x5mg daily, and have not had any side effects or any other problems from it.

[Afbiff]

I have been on Apixaban since March (2x5mg a day) and was concerned at first, but not now. I have had the odd minor cut which bleeds for a little longer and then stops and a couple of bruises which are a bit more colourful than usual. So, I've forgotten about it and feel no ill effects and I'm reassured by being protected from stroke risk. Good luck with yours.

[WendyWu20]

I used to take Apixaban 5mg X 2 daily. My main problem was that my hair started falling out in a week or so, and took about 6 months to settle, it was quite worrying. Then I lost weight and it started falling out again, I guess it was the lower body mass and the same amount of Apixaban. I also found that I just wasn't healing at all, from everyday cuts, I always had plasters stuck on and sometimes they would get infected. Normally a little cut would heal in a day or so.

[Hidden in reply to WendyWu20]

Did the hair loss resolve on having the dose reduced, or were you switched to a different NOAC? Also, like you, I have been prescribed 2x 5mg- do you know if this is the minimum dose or can you, in principle, take less?

[WendyWu20 in reply to Hidden]

The minimum dose is 2.5mg X2 daily, if you are under a certain weight. The hair loss resolved immediately when I took myself off all medications, including Apixaban and Flecainide. I don't recommend this for anyone else. I did this because I had been working with a spiritual healer and have not had any AF since :o)

[Luludean]

What a great deal of positive comments about Apixaban !!

I have been in Rivaraxaban for 4 years and have repeatedly posted about increasing joint pain ( I asked my specialist if the pain was due to the drug and, he was very rude to me!!!!)

Do people get more joint pain when put on Apixaban? From the posts there seem to be few complaints.

What are the differences between these 2 drugs ?

[Mrsvemb in reply to Luludean]

It is interesting what you say about rivaroxaban I too have increasingly worse joint pain, but I was blaming it on the Bisoprolol. I have been on Rivaroxaban for more than two years. Prior to that I was on Apixiban which caused bad nausea and hair loss. I still get the hair loss with rivaroxaban. I have had no gastric problems with rivaroxaban, but with Apixiban the nausea was very bad.

Val

[Luludean in reply to Mrsvemb]

Thank you for reply.

[Hidden]

Hi I have been on them for a year now with no side effects I take 5mg 2times a day

[Hidden]

Dose is generally 5mg x 2 daily, but can be reduced to 2.5 x2 for the very elderly (80+), those weighing under 60kg or those with compromised kidney function.

Suggest you do an internet search & download the patient info leaflets for Apixaban & Rivaroxaban.

Some people would see Rivaroxaban as more convenient as it is one dose a day, however, unless taken with a fatty meal it can be less effective and also seems to have more side effects, especially gastric ones.

I and many others tolerate Apixaban very well. I’ve been on it for over a year & the only side effects I noticed at first were a little extra hair loss which settled after a few weeks, and my gums bled more easily, but additional care to dental hygiene stopped this.

Hope this is helpful

Pat x

[Luludean in reply to Hidden]

Thank you!

I don’t know what would be worse (my being stupidly vain)

Joint pain is unpleasant????? But losing my hair would tip

Me over the edge!

I know many many people have to endure this and do so with bravery.

[Hidden in reply to Luludean]

The hair loss was very temporary & very minor - just noticed a bit of extra hair in my hair brush for about 6 weeks. Nothing to worry about at all - my hair is my one vanity👩‍🦳

Pat x

[Luludean in reply to Hidden]

O Pat that is better news!!!!!!

My hair ,is ONE ( the main one) of my necessities! I am amazingly shallow🤭🤭🤭

[Buffafly in reply to Luludean]

I don't think the hair falls out, it seems to break easily. So I have lots of fuzzy 'new growth', felt Rivaroxaban was worse than Apixaban for that.

[Hidden]

I'm a cynic , but my guess is it's cheaper

[healme]

I wish I could be as positive about Apixaban. I am reassured by the knowledge that 5mg twice aday is doing it's job of reducing the risk of another stroke but unfortunately I have other problems that require other meds including Amlodipine, Atorvastatin, Lansoprazole, Losartan and Flecainide so perhaps it is one of the others or the interaction of them all but shortly after starting Apixaban I began losing my hair and my skin became sensitive and itchy and I now suffer from eczema which is often inflamed and infected something that I have never suffered from before. I'm afraid I am quite vain and took my thick hair and good skin for granted for the past 60 years. My GP disagrees with my view and dosnt want to risk changing any of my meds but I am convinced that the Apixaban is responsible.

[Hidden in reply to healme]

Several people have reported hair loss in their replies. NHS choices claims that “Some people report hair loss when taking certain anticoagulants. Apixaban does not seem to affect the hair or cause hair loss.” Why, then, the discrepancy? I incline to the view that Apixaban and other NOACS *do* cause hair loss in some people- some medical papers even specify a possible mechanism for this. If NOACS do not cause hair loss, GPs should be able to refer to some study or studies which demonstrates this. I doubt very much whether such a studies exist. Did you manage to resolve this problem?

[healme in reply to Hidden]

My hair has never regained it's thickness but it isn't falling out so much anymore. My skin is a bigger issue for me as being on Anticoagulants means it bleeds if I catch it and it is very slow to heal. To think just three years ago I was only taking Lansoprazole for my hiatus hernia and statins for cholesterol with no side effects until the AF started. I wonder sometimes what came first the chicken or the egg 🤔

[Thomas45]

I have solved the problematic side effects of the newer anticoagulants by going back to Warfarin, whose only side effect is sometimes finger nails are brittle. I have my own Coaguchek meter so can check that Warfarin is working whenever I want. I can eat what I want. I email my INR readings to the Arrhythmia nurse and she emails back my dose, which hasn't altered for 2years.

I tried Rivaroxaban but had a very rare side effect, intense pain throughout my body, so for me it's a case of once bitten twice shy, back to the tried and tested Warfarin.

[Hidden in reply to Thomas45]

One big advantage of warfarin is that it is a known quantity, i.e. much more is known about its effects than the newer NOACS. A friend takes warfarin following a heart bypass and has been fine with it- although he finds it a nuisance to have to go for the regular checks for the correct dosage level.

[Thomas45 in reply to Hidden]

I get over that my having bought my own Coaguchek meter. I visit the Arrhythmia nurse once a year to check my meter against the Medical centre's

[Seawalk in reply to Thomas45]

As I am having so much trouble with NOACS I’ve been looking into warfarin -scary - yet thought great if one can self check. I can get a coaguchek machine but the strips are expensive. Do you get them on prescription. I’ve yet to discuss all this with my GP. Just want to be informed first. Thank you.

[Thomas45 in reply to Seawalk]

Yes the medical centre /arrhythmia nurse give me them when needed. I receive a canister containing about 25 strips. When I am running out of them they give me some more. They don't give me a prescription for them but the strips themselves, with lancets when needed.

[Seawalk in reply to Thomas45]

Thank you.

[Flystar in reply to Thomas45]

My doctors will not give me anymore strips either on pescription neither does my local hospital so I am having to buy them myself I live in the UK

[Thomas45 in reply to Flystar]

Why not? It appears you've had them in the past, by the word "anymore"

[Seawalk]

The EP I saw said to quote - everyone north of the Thames with AF were being prescribed Edoxaban as the CCG had done a deal with the company -

I’ve had severe muscle, abdominal pain and weakness with Apixaban. I tested it it out my stopping and starting the drug three different times. RIvaroxaban cause me gastritis and I have now been on Edoxaban for 5weeks and by afternoon can hardly walk with leg pain and muscle weakness, also headaches! These are affecting QOL much more than AF did. Sorry if this is too much information.

[bayonnejoe1]

Just a note on cost here in the States. Heavy discounting seems to be happening with Apixaban (Eliquis). My Medicare Advantage provider (Humana) was charging me $90 for a 3 month supply of 180 5mg pills. I take 5 mg x 2 daily. 6 months ago that dropped to $30 for 180 pills. If you're in the States it's probably a good idea to look around for the best pricing.

[Hidden in reply to bayonnejoe1]

Thanks for the information. The big worry with all of these NOACS is bleeding on the brain. Nobody here has referred to such an event but apparently the risk is 1 in 100 per year.

[bayonnejoe1 in reply to Hidden]

Yes. 1 in 100 for bleeding. Or 5 in 100 for a clot stroke without. Pick your poison. I've had the stroke. So for me, I find the better odds reassuring.

[DawnTX in reply to bayonnejoe1]

wow I cannot believe you pay that much through Humana. I have a zero co-pay for it. I know every state and every county is different. I have the PPO advantage now I prefer the HMO but it’s not available since I moved to Texas. Sometimes it is worth checking out good RX I have used it for a few meds, the last one I used it for it cut it by $30 CVS at least here will not except it even though their name is on the coupon. Usually Walmart is the best place. If you’re in the states you do have to shop if you’re getting something different Humana, has just told me they do not supply my metropolol or Multaq. The good thing is I am off of both of those, but I don’t understand they are not high priced meds that’s big Pharma for you I believe they dictate and I don’t like it.

[trish1940]

I was on riveroxiban it caused bleed.. i had to have blood transfusion. On Apixaban i okay.

[voyagersprit]

I have been on 2 x 5mg Apixaban for 3 years

No side effects whatsoever

[foxglove1]

I've been on Apixoban for three years with no ill effects I have also had several sun damage skin things removed (with sutures) with no problems. My consultant felt no need to stop Apixoban prior to the procedures and there was no excessive bleeding afterwards.

[Hidden in reply to foxglove1]

Thanks for your comment. Most people seem to be very positive about Apixaban.

[foxglove1]

noted your doctors comments on bleeding. My consultant (London teaching hospital) when putting me on Apixoban told me I had less chance of a cranial bleed on it. did not mention risk of gastro bleed. Hopefully I shall not find out

[Hidden in reply to foxglove1]

A cranial bleed is one of the big worries about taking an anticoagulant. Doctors rarely mention this risk unless you ask them. I was told the risk was about 1 in 100 per year, which seems to me to be on the high side.