NOAC - should I take? which one?

[Carew]

Tendency to AF - without other symptoms. HR rises - then drops, often within seconds. Say 170 down to 85 and back up and down repeatedly.

Watched a full screen live monitor and could see what was happening but absolutely no change to how I felt at all. No obvious change by lying down or sitting up.

Very rarely aware of HR. And pretty sure it isn't continuous but happens for a while then fades away.

Being pushed towards NOAC. Seems the concern is my having a stroke. There is a 20mg Rivaroxaban paper prescription sitting next to me right now. (I think I could get it changed easily enough to Apixaban.)

Ferritin currently high (377) - probably due to inflammation.

I'd feel much happier if they could offer 5mg for a while, then 10, 15, and only take 20 after at least a few weeks of escalation. But that seems not to be how things are done. (Ignoring cost issues, of course.)

[Hidden]

Good Morning Carew, you may like to take a look at our Patient Information booklet 'Preventing an AF Related Stroke' and Information Sheet on Rivaroxaban here: heartrhythmalliance.org/afa... I hope you find them helpful. 20mg Rivaroxaban is the usual dose prescribed, unless kidney function is impaired. Please feel free to contact our Patient Services Team [e-mail] if you would like any further information or support.

[Carew in reply to Hidden]

Thank you, Katrina.

My GP noted that I have gone into At Risk - due to age.

[Buffafly]

Just my personal opinion, I would change to Apixaban. I’ve had both and felt much better for the change.

[Carew in reply to Buffafly]

Thank you.

Can you explain further about how you felt better on Apixaban?

Whichever I go with, I'd like to understand what issues might make one preferable to the other. Obviously, if I go with Rivaroxaban and don't have the same as you, there would not be the same reason to change. But if I do, I would probably recognise that switching might be sensible.

[secondtry in reply to Carew]

My cardiologist no longer favours Rivaroxaban due to research in the States - sorry he gave no details. He suggests Edoxaban because it is cheaper but it appears Apixaban is the favourite here.

[Carew in reply to secondtry]

Thank you.

I think I'm moving towards Apixaban.

[secondtry in reply to Carew]

I would also retest Ferritin levels and if still high consider blood letting/doning (if accepted) to reduce it as not good for cardiovascular health.

[Carew in reply to secondtry]

I did consider giving some blood but for some reason (can't remember what) I was not eligible at the time my appointment came up.

[secondtry in reply to Carew]

Evidently it is the only way if your ferritin remains stubbornly high. Some Alternative Practitioners will do blood letting. My London Naturopath offered it but I declined and the level went down on its own accord, probably due to incremental diet changes.

[Buffafly]

Rivaroxaban irritated my stomach and I had more bruising and bleeding on it. Also it is recommended to be taken with ‘a full meal’ containing fat to be most effective. But I have bowel problems and sometimes need to starve for a day or two so that meant that just when I was most likely to go into AF due to tummy upset the Rivaroxaban was more likely to be ineffective and upset my digestive system more. Apixaban seems to have more ‘even’ effect and no dietary restrictions. Best wishes ❤️‍🩹

[Carew in reply to Buffafly]

Thank you again.

That is a very helpful explanation. I didn't realise the effect was such that patients actually feel an effect - and whether it is even or not.

[Buffafly in reply to Carew]

Lots of people are happy with Rivaroxaban but on this forum Apixaban seems to be favourite.

[mjames1]

Not sure what "tendency to afib" means? Do you have a cardiologist or ep? Much more knowledgeable than a GP re afib. Have you worn a Halter type device to confirm the frequency and duration of the afib episodes? If not, that's where I would start. Also, what is you CHADS2VASC score? You can "google" it or ask your doctor if you don't know. Once you have more information, I think you will have a better answer for your question.

Jim

[Carew in reply to mjames1]

A tendency to get afib, as seen on ECG, but none of the commonly reported symptoms. I know some people get pain - I literally cannot tell.

I have been seen by a cardio. About a year or so ago. I was given Bisoprolol but decided not to take them.

Some years back, when first found to have high HR, I had a Holter for, if memory serves, a day or two. Nothing found at the time. They wanted to prescribe permanent statins and beta blockers. My cholesterol was extremely low at the time so it seems to be prescribe-by-formula. I rejected both.

My score is now 1.

Basically, my GP noticed I have had a birthday so my score went up.

[SeanJax]

It seems you don’t like medication. Stroke is a life changing event. Your body your choices.

[Carew in reply to SeanJax]

Thank you.

I have seen too many adverse events from medicines to take on trust.

One example, someone given Clopidogrel and kept on it indefinitely. I pointed out the contraindications, the adverse events/side effects and the prescribing information but they would not withdraw it.

Eventually, after far too long, they did stop it and this person improved considerably within days.

[secondtry in reply to Carew]

I share the same sentiments but I think the real 'art' of keeping healthy is to force yourself to take a balanced view. I turned down statins for 'high' cholesterol and glad I did but had to go against my wishes to stop AF by starting Flecainide and glad I did. Never stop improving your lifestyle choices and looking to reduce medication & supplements is my current mantra.

[Carew in reply to secondtry]

Thanks again.

If I actually suffered from AF, it would make the decision easier. But it was first identified entirely by accident and I have never noticed symptoms from it. Which makes it seem distant and unreal. Rather like reading about it in someone else - not me.

[jeanjeannie50]

My very experienced AF nurse told me that she never thought she would like any of the newer anticoagulants, preferring the effectiveness of Warfarin. She has changed her mind now and thinks Apixaban is the best after reading so many good reports about it.

Jean

[Carew in reply to jeanjeannie50]

Thank you.