Hi,

[Chris1945]

Looking for some sage advice, I've been on this forum before but not for a while. Many moons ago I was diagnosed with PAF which weirdly, only ever happens during the night so I'm sure there is a digestive association with it. Anyway, long story short, I was put onto Warfarin for a few years but as a vegan/veggie, was limited with how much green stuff I could eat so medication was changed to Apixaban which tbh has been great, however, over time I've developed awful aches and pains in my muscles and joints which are excruciating at times and it turns out the culprit is the Apixaban which I've now read, can affect joints and muscles and for sure, mine are now worse and in constant pain. Cardiologist has offered me either Edoxaban or Rivaroxaban so I'm looking for advice from anybody on either of these pills who can help me decide which might be the best pill which allows green stuff as well as reduces aches and pains! Thanks in advance....x

[rosyG]

We can't advise re medication as don't have your medical records but from memory I think Riveroxaban is unsuited to some with stomach issues. Sounds like vagal Af if just at night ( like me!) I am careful not to sleep on my left side Ask your GP which would be best

[Megams in reply to rosyG]

~Aha will be interesting to see how my sensitive tum handles the increased dose (20mg) like in the past when awaiting ablation August 2021.I felt nauseous lot of time even tho I placed the pill in an acid resistant capsule to break down in the large intestine & leave stomach region/small intestine alone - lets see !!

[Chris1945 in reply to rosyG]

Yes, definitely vagal nerve gets irritated and I've seen a video by Sanjay Gupta who is a cardiologist in York hospital who says there is most definitely a connection between the gut health and AF....he has videos on youtube that are worth checking. Coincidently, I had both ends checked only last year and I was found to have an 'overly long colon' and a sliding hiatus hernia both of which can irritate the vagus nerve so it make sense to me when I'm flat out at night that those might be causing the nocturnal afib? But for now it's ever onwards...x

[Buffafly]

Hi, I take Apixaban but unfortunately my aches and pains are down to osteoarthritis and my age so no point in a change especially as Apixaban suits me very well, unlike Rivaroxaban, which generally doesn’t have a great reputation, also tricky to take as it has to be taken with a meal containing fat to get the full effect.

[BobD Volunteer]

To be honest there is nothing wrong with warfarin once you adjust the dose to match your diet. Doesn't matter if you take 4 mg or 14mg so long as INR is stable.

[Chris1945 in reply to BobD]

Hi Bob, I'm not against Warfarin per se but I do love lots of greens so just wondering if I did end up back on it, if it's worthwhile getting one of the self-testing at home machines, do you have one? That way I could get a better idea of how to regulate things. I know they're not cheap but I think I might be worth it!

[BobD Volunteer in reply to Chris1945]

I recently inherited one from my dec'd brother in law but ony use it either when instructed by my INR clinic or if I change drug regime or similar. The only dietary restrictions are consistency. Once you have adjusted your warfarin dose to your diet it would of course be madness to suddenly change diet but if you always eat lots of greens then no problem . I tested just after the Christmas break anf found that all the food including cranberry sauce, sprouts, broccolli etc had pushed me near the top limit of 3 so I re tested a week later by which time it was back to my normal low 2s.

I know of at least one member who takes vit K tablets as way of stabilising INR. Once you get the dose right then any % variation from normal diet is minimal. Remember that the amount of warfarin you take is of no importance, only the results so 4 or 14mg is OK if INR stable.

[secondtry]

All things being equal my vote is Edoxaban. My cardiologist said, around 2018, that new research in the States did not favour Rivaroxaban.

[Megams in reply to secondtry]

~Hi secondtry - can you please elaborate as to the research mentioned in USA via not being in favour of Rivaroxaban?Appreciated in advance ~

[secondtry in reply to Megams]

Sorry my cardio didn't elaborate & I didn't quiz him as too many other Q's to get through in a short time!

[Megams in reply to secondtry]

~No problem at all and can perfectly understand time being of the essence ~ many thanks anyway ~

[pascaltaskin in reply to Megams]

Could this be the research?

pcori.org/sites/default/fil...

This is the outline, but there's a link, near the end, to the details of the research. It seems to indicate that Apixaban is the best of the bunch, which is tiresome if its side effects are so troublesome for you. But for me it confirmed what I felt about Rivaroxaban when I was put on it for a short time - the bleeding really bothered me. I'd have been quite happy to go back to Warfarin (as before covid, but the need for INR tests made it difficult for my doctors' surgery who have been brilliant in attending to all sorts of silly problems during the period of restrictions), though taking a high dose to compensate for eating healthy vegetables seemed a bit contrary.

Good luck in your searches!

[Megams in reply to pascaltaskin]

~Most interesting reading about Rivaroxaban - thank you very much indeed.

[Snowgirl65]

I've been on Rivaroxaban for 8 years with no problems.

[Mira265]

Well ChrisI have been on Warfarin for many years and have got on well with it. I limit dark green veg and broccoli to small amounts because of the Vitamin K. Other than that I treat alcohol the same. They say it is better to have small amounts regularly than not at all then have a large portion.

Hope this helps.

[Chris1945 in reply to Mira265]

Thanks for responding, I know it's odd but I really love greens , the more the merrier!

[Sandpoet1498]

I have been on warfarin for an artificial heart valve for 13 years and self monitor INR every two weeks with the home testing Coagchek meter. My doctor gave me a dosage plan which allows me to adjust my intake to stay in range. My range is 2.5-3.5.I am a very healthy eater and wife is vegetarian. It is true the greens will lower your INR below the desired range.

His advice is to adjust dosage, not diet. He prescribed 2.5mg tablets so subtle adjustments are possible without splitting pills. Since I test at home every two weeks, I can do additional tests if I notice any unusual bleeding or bruising or I have eaten different on a vacation or altered my diet for any reason.

I have been taking 7.5-10mg/ a day for years and only occasionally move to different dosing over the entire time.

If I were you I would inquire into home testing and get back on Warfarin so you can monitor your levels and adjust as necessary without going to a testing site.

[Chris1945 in reply to Sandpoet1498]

Ah right, I've just asked BobD if he has a machine , might look into getting one, I certainly had no pain problems on Warfarin. x

[Chris1945]

Hi everyone, sorry for delay in responding to you all and thank you so much for your comments and advice. I'm due to see my Cardiologist in the next week or so and will discuss everything with him and take things from there...ever onwards!