I'm non Afib most of time (Afib attacks 5-6/yr.) Doc says Eliquis but 200 mg. Flaccanide gets me in sinus in 4 hrs. Must I take Eliquis too?

[Daver112]

I'm a 76 yrs. old male, in excellent health and very active. If I have 4 to 6 bouts of Afib a year it's usually when I overdo things like heavy skiing, yard work or hiking and then have a few beers (2 to no more than 4) later. I now know this is not good for my Afib and am getting better recognizing the connection.

Rather than take the prescribed Eliquis daily, which I was told at Walmart cost $1600+/- for a 3 months supply, can I just rely on my flecainide when I enter Afib instead. This flecainide always gets me out of Afib within 4 hours of resting and then I go merrily about my way until I forget and overdo things again.

I guess I'm saying that if my heart is in sinus 90% of the time and blood clots occur or form more often when Afib occurs, can I rely on this non-Eliquis flecainide method as an alternative to preventing a stroke do to Afib?

I really don't want to take any more meds and especially Eliquis since I already take 10 mg. of lisinopril and 25 mg of metropolo daily. I'm afraid that being so active I may bleed out if ever injured seriously. I'm also afraid of more side effects on top of the drugs I’m already taking.

Comments would be greatly appreciated as I'm at a crossroads and today or tomorrow I'll be making better healthier life choice changes and would prefer to avoid the pill popping way.

[BobD Volunteer]

The amount of time you are in AF and severity of events has no bearing on the stroke risk which you have due to AF. This makes you five times more at risk of life changing stroke. Your choice.

[Daver112 in reply to BobD]

Hi Bob, many thanks for your reply.

What I'm having difficulty understanding and never asked my doctor is why, when I'm in natural heart rhythm which is 95% of the time and all is well, must I have a blood thinner or whatever (protein blocker) like Eliquis?

Are you saying that when I go into Afib for those 4 hours (so far so good at max. 4 hrs.) that this is my stroke or clot creating critical time? Or are you saying because I have 4 to 5 brief Afib episodes a year I'm also at great risk of a stroke without Eliquis during those 95% times all is well and I'm in normal rhythm?

I guess I'm asking why am I at 5 times more likely to have a stroke when for the past 3 months my heart rhythm's been fine and all is good? It seems you're saying that during the brief Afib episodes clots that may have formed may have corrected themselves and I've just been lucky? Is that it?

Honestly, I don't fully understand why if I can get back into sinus quickly that I have to take Eliquis unless I've just been lucky during these episodes and if that's the case I may have answered my own question.

I sincerely do appreciate your feedback and will ask my doctor again, if I can ever reach him during my once a year visit. As a matter of fact the once a year visit itself may well be giving me a false sense of security too. In any case I'll certainly let you know what I've decided and will start looking for a cheaper way than $1600 / 3-mo. supply of Eliquis

[BobD Volunteer in reply to Daver112]

How do you know you only have a few AF episodes? Many people have "silent" AF they are quite unaware of. Just having AF is risk enough.

[Daver112 in reply to BobD]

Thank you. I guess I must admit I've had little brief palpitations lasting 1 to 2 minutes on occasion enough so that I've thought about possibly going into AF but never have as yet. My episodes are usually caused by things I'm now becoming much more aware of as I'm becoming more attentive to my activities.

Bob, many thanks again for staying with me and I sincerely wish you all the best and I'll check in again. Thank you for your brief succinct good advice.

DR

[absolutepatsy in reply to Daver112]

You could be having AF episodes when you sleep. As BobD says "silent AF". Keep well and I wish you all the best.

[Bagrat]

Very unlikely you will bleed out on eliquis. Pressure for a wee bit longer than usual if you cut yourself. Internal bleeding is a bugger anyway and lots of supportive care available until it is controlled whether you're on Eliquis or not. As Bob says your choice but as such an active guy wouldn't think you'd find coping with a stroke easy

[Daver112 in reply to Bagrat]

Thank you Bagrat. Same as my doctor said too. Damn. Appreciate very much your feedback.

[Bagrat in reply to Daver112]

I swapped from warfarin a couple of years back and have had no problems or side effects. My last episode of AF was 2013 but still take Eliquis

[Daver112 in reply to Bagrat]

Again thank you and thanks to all. Probably will take the caution route now.

[5195]

Hi Dave

I understand your dilemma as I too am really in a quandary about this issue, I have had x3 episodes of AF in 10 years each lasting no longer than four hours and I am also a very active 65 yr old. I have had conflicting advice from my local GP’s regarding the need in their opinion for taking a NOAC but my cardiologist Dr Sanjay Gupta explains that it’s your overall risk not the amount of AF episodes that matters - (the CHADS VAS Score and BLED score) You can watch him explain this on You Tube (Dr Sanjay Gupta York Cardiology)

Have to admit though I’m still sat on the fence.

[Bagrat in reply to 5195]

I'm surprised jeanjeannie50 isn't green with envy. I have had one consult with him which I paid for for reassurance as discharged from clinic many moons ago

[Daver112 in reply to 5195]

Yes, me too but must face up to it that life can be difficult as we age. I'm leaning towards the Eliquis route. My score was 3.1 which if I understand that test which Bob directed me too means 3.1% chance in a 100 which is small. I must not be understanding it at my quick glance. DR

[Desanthony]

Your Afib and your age give you a higher chad vasc score so that is why they keep you on Eliquis. It is the same for me. I had my first successful cardioversion just before I was 75 and asked could I come off Eliquis but the answer was no as my age kept me in the "danger zone" so to speak. That time I went back into Af in about 11 months. I have since had another 2 Cardioversions and am still in normal sinus rhythm NSR after the last CV while waiting for an ablation which I should have had this month but received a letter last week telling me that all elective procedures at the hospital had been cancelled for the next 3 months.

Of course you don't have to take Eliquis if you don't want to but you are at higher risk of having a stroke without taking it.

[Daver112 in reply to Desanthony]

I do understand and I'll have to brush up on what exactly my 3.1 score means. DR

[Tryfan]

Well Daver. Your post reflects my situation. I decided arbitrarily to stop taking Apixaban. Like you events are some distance apart, and one knows when your in sinus or not.

Move on a couple of months and all credit to my GP I was contacted as I hadn't put in a repeat prescription. Asked why I gave the reasons you give. Two weeks later I was sent a copy of the Consultant letter to the GP. Again, all credit to GP he wrote asking Consultant for his views. In no uncertain terms the letter said. It's his life and if he wants to take the risk of thrombosis it's up to him.

Sorry to be so wordy but this it what your decision has to be based upon. I started to take Apixaban again. As as far as I could tell I have no side effects. Its risk thrombosis or not its that stark.

[Daver112 in reply to Tryfan]

Tryfan, thank you and all others for your replies. My doc. told me that my body can handle Eliquis with no problem and he said it's very safe. Unfortunately at my age 76 it seems all young doctors today immediately just go to pill medications and us old timers still hang on to regular exercise, vitamins, everything in moderation and good diet will take care of everything.

Well it's hard to change this imbedded thinking but I'm moving towards Eliquis. If someone tells me that yes the 3.1 results means 3% chance in a 100 I'll have a stroke it'll again be a difficult choice again.

[Auriculaire]

I have much less afib than you - only 7 episodes since Aug 2015 ( and one of those after major surgery ) . I had no comorbidities but still had a TIA when I was 66 - 6 months after the last afib attack. I started Apixaban. The 2 episodes I have had since have been far less anxiety provoking as I now feel the Apixaban is protecting me. Are there no cheaper NOAC s you could get? I thought Edoxaban was cheaper.

[MarkS]

The fact that you have any AF means your heart is inflamed. It is this inflammation that is mainly responsible for increasing your risk of stroke. So it doesn't matter if you have AF every day or once in a blue moon, you are at increased risk of a stroke.

I was super-fit with no other medical issues apart from AF and yet I still had a TIA 10 years ago. I went onto warfarin which I've been on ever since. It's as cheap as chips so you could consider that, but you would need to control it well, which is not so easy in the US.

I still cycle, sail and climb mountains so it needn't affect your life too much.

[Daver112 in reply to MarkS]

Boy, that's really good news Mark and congratulations. I can feel a sense of urgency brewing in my mind to bite the bullet and consider Eliquis as a necessary life insurance policy expense to insure my continued health as best I can proactively do.

[jwsonoma]

I was told a life threatening clot could form with in minutes of an afib event.

I have been on Warfarin for several years with home testing.It is very inexpensive. The expense and inconvenience is in the testing. If you eat a regular quantity of greens every day your INR (degree of clotability) should be steady and testing isn't done that often. I am plant based and eat a lot of varied greens so I self test.

[macdongr]

The CHA2DS2-VASc score suggests any male over 75 years of age, whether having Afib or not, take one type or other, of the new anticoagulation therapies. Eliquis is excellent.

These drugs reduce stroke risk by about 50%. Worth it. Strokes in older adults are absolutely devastating and recovery is rare.