Dabigatran or Apixaban?

I notice that a lot of AF patients on this forum mention Apixaban as their anticoagulant as opposed to Dabigatran (as I take ) or other NOACs. Has anyone been told Apixaban is a better option for AF sufferers? I asked for Dabigatran as it was the only NOAC with a reversal agent at the time.

[CDreamer]

Apixaban for me every time. I had gastric issue on Dabigatran. My husband still takes it and has found a routine which suits him and no longer causes the acid reflux - always take with food, not any carbohydrates so fruit or cheese is good.

Everyone reacts differently.

[Hidden in reply to CDreamer]

I will watch out for the gastric issues, but I also take Sotalol which can also cause gastric issues.

[Hidden]

In terms of side effects, Apixaban appears to be fairly benign. The experts seem to suggest that an intracranial bleed is very marginally less likely and because the dose is 2 x 12 hours, should you need to miss or accidentally miss a dose, it’s less of a problem. Whilst it’s understandable, the reversal agent issue in reality tends to be less of a problem. If something serious happened, provided you got to hospital in time, we are told they would be able to deal with it regardless of what anticoagulant was taken......

[Hidden in reply to Hidden]

Thanks for your reply.If I get any gastric issues I will ask about Apixaban, which I believe now has a reversal agent. Before Dabigatran had a reversal agent there were a lot of deaths in the US when ER doctors were unable to stop bleeding. Dabigatran was approved by the FDA as not requiring monitoring and this helped the company to sell it to health insurers. However, some patients were found to accumulate the drug due to poor renal function which could enhance the anticoagulation effect up to five times. I note that patients on NOACs are recommended to have full CrCl tests rather than the estimated figure commonly used.

[CDreamer in reply to Hidden]

The reason for that was researched & found to be that in people who had renal problems, the drug hadn’t metabolized in the body. The gel coating requires an acid environment so if taken in empty stomach with water the gel coating wouldn’t dissolve so the active agent wasn’t absorbed thus causing problem.

Also Dabigatran was the first DOAC to be approved & in the early days the dosage was not adjusted for those 80+ and underweight, effectively overdosing.

[Hidden in reply to CDreamer]

If the active agent wasn't being absorbed doesn't that the anticoagulation effect would be reduced, not enhanced which was causing the bleeds?

[CDreamer in reply to Hidden]

Exactly - in the early days the dosage was not appropriate for many. If not absorbed it was ineffective as anticoagulant & when dosage was incorrect caused bleeds. I think originally it was once a day?

When mal-absorbed because the gel coating didn’t dissolve, the liver & kidneys need to work a lot harder to expel the chemicals which can overload them and is why you need regular monitoring for kidney/liver function.

[barneyfrances in reply to CDreamer]

Very interested with your reply, can you please clarify for me - are you saying Apixaban should be taken with food? the reason I ask is because I have been on Apixiban for 2 years and have had a serious decline in my kidney function and am having my liver investigated - I asked my GP if there was a connection - she thinks it is just a coincidence, Normally I take first dose with a full glass of water in the morning and the same in the evening, never with food. Have I been doing it all wrong ? Look forward to your advice..... thankyou

[CDreamer in reply to barneyfrances]

It’s Dabigatran I found needs to be taken with food, not Apixaban - having said that I take my morning dose after breakfast & evening about an hour after evening meal. Just makes sense to me to not take on completely empty stomach as we know meds can irritate gastric tract but liver & kidneys - so many things can go wrong but I wouldn’t discount the idea.

I’m sorry to hear about your problems & hope you get to the bottom of the cause.

Rivoroxaban does need to be taken with ‘a substantial meal’.

[Hidden in reply to barneyfrances]

I'm sure your GP will identify the problem. If a drug says take with or without food I would always take it with food. Many prescription drugs have unwanted effects on the gastrointestinal system so I think it's good policy to take with food so the drug passes through the gastrointestinal system with as little effect as possible before it goes into the bloodstream and starts to do it's job.

[Hidden in reply to Hidden]

Yes, this was posted a few days ago.

healthunlocked.com/afassoci...

[GrannyE in reply to Hidden]

That is different from what my doc told me. He said that if anything serious happened all they could do is to make me comfortable while I bleed. Prefer your doc.

[Hidden in reply to GrannyE]

How long ago was that Granny?

[GrannyE in reply to Hidden]

When I was first put on it about 2017 I think.

[Hidden in reply to GrannyE]

I think things have changed a bit since then but the problem is getting to the hospital in time for them to help which is why alert cards or similar are so important.....

[GrannyE in reply to Hidden]

I wear a pendant round my neck and carry alert cards so am hopeful that they might work in case of emergency and I am unable to tell people.

[Buffafly in reply to GrannyE]

😳 What?! That is ridiculous, the same would apply to aspirin, clopidogrel and all DOACs - if it were true.......

[Hidden in reply to GrannyE]

Rivaroxaban, Apixaban and Dabigatran now each have a reversal agent. When my prescription runs out I am going to ask to be changed to Apixaban, as this seems to have the best reputation.

[GrannyE in reply to Hidden]

have just looked it up and glory be you are right there is one now. It was approved by the FDA in 2018. That makes me feel much better. - not that I have been worrying over much about the what ifs...............but thanks

[jeanjeannie50]

I asked my AF nurse her views on anticoagulants and she replied that when the NOAC's came out she never thought anything would be better than Warfarin. She's now changed her mind and sings the praises of Apixiban over the other choices.

Jean

[TamlaMotown]

Hi mike2015, I was told by the pharmacist attached to my GP surgery that Apixaban was the most likely to not cause a bleed so I chose that

[Finvola]

When my cardiologist prescribed Apixaban, he said it had the lowest bleed factor of those available at the time - that was 7 years ago. I think the reversal agent is a bit of a red herring as there are generic treatments available in A&E for a severe bleeding and with a catastrophic bleed, that may be the first line of defence.

[Hidden in reply to Finvola]

I was told by my GP that bleeds could be stopped by other methods but that did not seem to be the case according to ER doctors when Dabigatran was first released without a reversal agent in the US.

[Finvola in reply to Hidden]

The US health system is very litigious and I can imagine that prescribers of anticoagulants in the US were very aware of what they might face. Just a guess.

[ramblerbaz3]

Hi mike2015.......I was diagnosed with PAF in September 2020 & was on Edoxaban as my anti coagulation, however for me this gave me gastric issues & was changed to Apixaban soon after. So far no problems 🤞

[Buffafly]

I used to take Rivaroxaban but changed to Apixaban because of the requirement to take Rivaroxaban with a meal. I have found Apixaban better in several ways, would always recommend it.

[GrannyE in reply to Buffafly]

In what ways better?

[Buffafly in reply to GrannyE]

No minor bleeding such as from gums or haemorrhoids (which led to the worry that unseen bleeding might also be taking place), less bruising, no stomach problems, less hair loss. There were also issues which I suspect were exacerbated by Rivaroxaban - joint pain (I notice Rivaroxaban is contraindicated for those with spinal deformity/fusion which I have) and eye problems - I have a condition which affects my retina and that got much worse while taking Rivaroxaban. I sometimes have flare ups of bowel problems best treated by fluids only at first but Rivaroxaban needs a meal to be fully effective.

[Hilly22]

I was given the choice between Rivaroxaban and Apixaban. I looked into it and learnt that Apixaban is superior to the others in every way. Most importantly there were fewer intercranial bleeds. No problems with it so far 😊

[Silver-Babe]

I take Apixaban and it suits me fine

[Aprilbday]

I’ve taken Dabigatran for 4 years now. I take with fatty snacks: Toast with butter, half sandwich, milk and crackers with cheese, yogurt-full fat. Before I learned on my own to do this, I got terrible acid reflux. Now not so much.

[The_Lord_is_with_Us]

My personal cardiologist prefers apixaban for all his patients. And the world-renown EP, Dr. Natale, who did my recent ablation also prefers apixaban. He did not stop it for the ablation. Said no problem being on Eliquis during the procedure, which surprised me.

[Jeaniebeans]

I take Rivaroxaban. I didnt realise that one NOAC had a reversal agent. If they all do the same job I wonder why that's not the drug of choice. Could it be cost?

[Karendeena in reply to Jeaniebeans]

Probably Jeaniebeans I was told apixabzn is expensive

[RoyMacDonald in reply to Karendeena]

5 mg Apixaban tablets costs £630 p.a. if taken according to the instructions dosage.

[Hidden in reply to RoyMacDonald]

That's about the same cost as Dabigatran so Apixaban seems like a preferred option, as it has a good reputation amongst doctors and patients and doesn't cause gastric issues.

[Hidden in reply to Jeaniebeans]

Rivaroxaban, Apixaban and Dabigatran all have a reversal agent.

[allanmichael]

I was given Apixaban instead of clopidogral. Seem to be no problems with it

[Karendeena]

Hi Mike, not sure really, although my mum (who has permanent af) was told by her cardiologist that apixaban was 'the cream' of NOACs. I believe it now has a reversal agent. Mum was once told by her GP that it needed to be changed because the alternative was cheaper, but I fought it and she stayed on apixaban. I am on it too

[GrannyE in reply to Karendeena]

Good for you

[DERLIN]

Whichever NOAC you take, how do you know the anticoagulation is enough for your body. What test is carried out? At least with Warfarin the INR test keeps you monitored

[Hidden in reply to DERLIN]

Warfarin has to be monitored as diet can affect the plasma levels of anticoagulation, whereas NOACs are not affected by diet.The NOAC dose is set according to the renal function of the patient before treatment and then checked every 6 months or so in case your kidney function has deteriorated.

If the dose is too high in a patient with poor renal function the anticoagulant can build up and increase the anticoagulation factor with obvious consequences.

[Shrek1974]

Hello Mike, I had been taking Rivaroxaban for nearly 2years (since diagnosis) without an issue but recently switched to Apixaban after a few months of Flecainide because it turns out I’m a bit daft when it comes to remembering a third medication time (yes, even with alarms - I can forget or get distracted in an impressive time), the full / empty stomach mix & 12hr shiftwork do not combine well with a third medication time & me.... So far quite happy on Apixaban too.Steve

[Dollcollector]

I have been on Rivaroxaban for 4 years with no issues as far as l know. Who knows what's going on inside your body. I do know that my hair has got thinner, but l put that down to old age. Now after reading everyone's messages l am wondering if l would be better off on Apixaban. It seems to be favoured by most people.

[DERLIN]

I understand that Apixaban can not be used with Valvular AF. What is valvular AF? I have AF, how do I know if it is valvular AF?

[Hidden in reply to DERLIN]

Typically mitral stenosis. Warfarin is recommended for AF associated with mitral stenosis and also mechanical mitral valve replacement.

The conclusions of the article cited below presumably supercede this view.

Echocardiogram will identify disease of any of the four heart valves.

journals.sagepub.com/doi/fu...