Apixaban (Eliquis) - Damage to Liver, Kidneys, Thrombocytopenia - Dilemma

[Ruza2020]

I have a major dilemma. My dilemma is this: do I continue taking the blood thinner (Apixaban) and bring about damage to my kidneys and liver, OR do I stop taking it and take chance having a stroke? But again, there is another huge fear: blood thinners do cause, in some people, hemorrhagic stroke.

So are we trading one type of stroke for another?!

I wander if anyone here has similar predicament.

Here is a short

I have developed paroxysmal atrial fibrillation about 16 months ago. My cardiologist wanted me to take Apixaban (2.5 mg twice a day). I initially refused to take that poison. But then every doctor and every nurse I saw insisted that I go on this medication. They all instilled a fear in me about getting a stroke if I don't take the blood thinner. I finally succumbed to the pressure - so I started taking Apixaban about eight months ago.

I week ago I had my blood drawn — well, analysis of my blood indicate that my Gamma Glutamyl Transferase and Alanine Aminotransferase levels are elevated — probably 150% higher than when I was NOT on Apixaban. My eGFR has dropped by 40% and my platelet level has plummeted…

Sometimes I wander if it is necessary for me to be on the blood thinner at all.

After all I am a healthy woman (if it wasn’t for the Afib).


My total cholesterol level is great. LDL is quit low, HDL is higher than normal and have no other ailments. My weight has always been at the lower end of the spectrum (BMI = 18.5).
I am on plant based diet. Actually, I never enjoyed eating any flesh, even as a kid. I don’t eat dairy either… I am very active, except during Afib episode - which tends to last very long now.


I am interested to hear if anyone else here has similar issues?

[CDreamer]

In short - YES - anti-coagulants are advised if you have AF, the overwhelming evidence of the efficacy of stroke prevention is now just about indisputable. If you have AF your biggest risk factor is stroke and AF induced strokes are more likely to be much more severe or fatal. Other good health factors will not mitigate your risk!

I don’t know at what stage the concerns for your liver and kidneys would outweigh the concern for your stroke risk? What information and advise were you given?

I have had elevated liver and kidney bloods a few times and all that happened was that I had blood draws more frequently to watch and they soon returned to normal. I don’t know how often you have yours, mine are monthly but at that time they were every week.

I think you need a lot more information and in the meantime I would suggest that you ensure you drink plenty of water.

Should you be unable to continue to take anti coagulants for medical reasons - there are other options such as Watchman Device but I don’t think doing nothing to mitigate the Stroke risk for us AF’ers is an option.

I think we have all had some resistance to taking anti coagulants initially but I have now been on them for 7 years with no ill affects but a few scares with elevated bloods. and What totally convinced me was having a TIA when, after ablation and no AF for over a year, I thought I was safe so I went off them against medical advice. I have been so enthusiastic to return to take any medication than I was to get back onto the A/C’s!

Even if you have had an ablation and you are not experiencing AF and if you are over 65 years - your risk of stroke remains so most of us now accept that we take them for life, period.

I know that isn’t what you want to hear, but it’s your reality now.

Best wishes CD.

[BobD Volunteer]

There are alternative anticoagulants to apixaban . That said the reason for the regular liver and kidney tests are not because anticoagulants can cause problems there but to check that function is normal as these organs have to excreet the drug. That there is apparently a problem may indicate some other issue which needs investigating rather than blaming the anticoagulant.

[Singwell in reply to BobD]

That is useful to hear as the OP made me panic a bit? What's the advised time period for testing? I had my bloods done just before lockdown as it happens but sometimes I have to prod our practice here to do their duty.

[RoyMacDonald]

Like you I was concerned about the side affects of Apixaban so I did not take it when I was diagnosed with SVT and I was OK for about 3 years then I had a major stroke. I did not take them because they can make a bleed worse. Observations while on the stroke ward made me realise that there is not much help they can give if you have a bleed but a stroke they can do quite a lot for and successfully. So much so that I made an almost full recovery in two weeks, that's from having complete right side paralysis. I'm 76.

All the best

Roy

[Ruza2020 in reply to RoyMacDonald]

Thank you Roy for replying, and for sharing.

I am sory to hear you had a stroke, but you are so lucky to have fully recovered.

Is your SVT permanent or paraxysmal? And are you taking blood thinners now?

Cheers

[RoyMacDonald in reply to Ruza2020]

Yes I take a 2.5 mg tablet twice a day. I only weigh 55 kg.

[avrambaer]

It's a tough call and each individual is unique. I am a 74 year-old male who has an atrial flutter, but I am asymptomatic and I was diagnosed with such four years ago. Initial anti-coagulant therapy with warfarin was dreadful. It caused a clot to leak in my eye and I was blind for three months until a victrectomy was performed to restore my sight. I also suffered gastrointestinal bleeding. It was terminated. I have minor kidney impairment, but there it is. I am not sclerotic and my CHAD score indicates a possibility of Afib-related stroke at 3% which is not statistically significant. What is your CHAD score?

If your CHAD score is not significant of a-Fib related stroke, why are you considering any anti-coagulant absent a personal history of neurological occurences? I was offered the Anthem device, but one must consume anti-coagulants for a period of at least three to six months before cessation. That's not a solution if the aim is to obviate their usage.

The "book" says a-Fib=anti-coagulant therapy. It is a dogmatic answer. Sportin' Life in Gershiwin's Porgy and Bess has a lyric, "What's writ in the bible ain't necessarily liable. It ain't necessarily so." Good luck. lol

[Ruza2020 in reply to avrambaer]

Thanks Avram for you input. What a horrific experience you had. Thanks God your eyesight has been restored.

My CHAD score is 2 --- 1 for being over 65 (I'm 72) and 1 for being a woman. Both out of my control:).

Cheers,

[Singwell in reply to Ruza2020]

If your score is 2 that's why they want you on anticoagulants. If your BP isn't high (check it over a period of a week) then maybe you can have the conversation with them about this. I'm younger than you - 64 - but my BP can elevate when I'm stressed or tired so I'm prepared to be on the anticoagulants. Remember that the score if 1 for your gender is simply due to statistics - more women get strokes than men.

[Nerja2012 in reply to Singwell]

Hi Ladies, hope you don't mind my butting in but your conversations fit me perfectly although I'm older at 76. Episodes about 10 month apart, no intervention, low BP etc so chads score 3 and all down to age and gender. Frightened to death of anticoags , feel like I'm walking through mud mentally.

[Singwell in reply to Nerja2012]

Not at all. It's also a judgement call on your part. Remember that many of these medical decisions are stats driven. If your BP is good and you have your episodes so infrequently then discuss this with your GP. Maybe if you undertook to test your BP twice a day?

[Nerja2012 in reply to Singwell]

I have just had my BP monitored for a week as I have a natural low diastolic and low heart rate, it came out on average 58/ 127 and pulse 52 which is normal for me. 1.25 bisoprolol doesn't seem to lower it too much but any higher in dose and I'm bracacardic , other than that I'm asthmatic which isn't a problem ither. I score very low on the hasbled score. My G P' said patients like me are in a very grey area but they just quote the chads score and go on that. I gave in and have been taking the lowest dose Apixiban for 3 weeks but I'm not comfortable at all taking it. I n 15 months I have had 1 episode of 6 hours which stopped itself . As you can imagine I'm very confused. I really do appreciate your reply as I don't know anybody personnely that I can talk to. Many thanks, M

[Singwell in reply to Nerja2012]

It is - according toy understanding - still your right to opt not to take the anticoagulants. What's the effect you're noticing?

[Nerja2012 in reply to Singwell]

It's mostly Anxiety I guess although I have had a bleed in my eye. I don't have any physical symptoms at all. Both of my parents had A F, My Dad took warfarin and died aged 65 of a bleed on the brain, my mother refused to take anticoagulants because of what happened to him and she's just died aged 98 and only took bisoprolol so here lies the problem. Thanks again.

[faridaro in reply to Ruza2020]

Ruza,

The new 2019 guidelines state:

"For patients with AF and an elevated CHA2DS2-VASc score of 2 or greater in

men or 3 or greater in women, oral anticoagulants are recommended."

See the link

acc.org/~/media/Non-Clinica...

and scroll down to Recommendations for Selecting an Anticoagulant Regimen—

Balancing Risks and Benefits.

You may want to bring it to your doctor's attention and see what he says.

[Ruza2020 in reply to faridaro]

Interesting -Thanks Faridaro.

My cardiologist told me that score of 2 or higher requires one to take anticoagulants.

Cheers

[faridaro in reply to Ruza2020]

" score of 2 or higher requires one to take anticoagulants" - that's according to the old guidelines. Your cardiologist may not be aware of the updated guidelines and you can bring it to his attention.

[ronaldcoul77]

I have been on Apixaban for5 years with no problems.If the Doc. has suggested you would be better off with this harmless drug.Take his advice and not us.I also have AF such a worry.

Regards Ron

[Ruza2020]

Thanks Ron. You are absolutely right, the Afib is a worry. It sure steals part of our life.

I sometimes feel I am two people (or one person with two personalities) - one when I fave Afib episode and the other when I don't.

Cheers,

[11ellis]

My kidney results have been fine on it. Also It doesn't matter how heathly a lifestyle you got . It's the fact is. your heart is frequently irregular. That is what causes a stroke.

I have annual blood test for my kidney function.

I've had no problem with Apixaban.

[Peony4575]

Am a novice to such things but if I read CHADs 2 aright they have removed gender and raised the age to 75 so you would score zero . ( people will jump in and correct me if I am wrong). I suffer with same dilemma as 65 one episode of AF to date and on aspirin 150mg which I have taken for a long time. It’s a rock and a hard place decision. If AF becomes more frequent I will have to cave and take a blood thinner. It’s horrible when you feel you are being damaged by a medication and let’s face it lots of people are

[sunlovah in reply to Peony4575]

Not sure that the NHS follow this, but go by the other Chad's score chart. Unless I'm wrong (was hoping it started st a 3. I'm a 2 , age and female)