There have been a few post recently about pressure to switch from apixaban to other anticoagulants. I’ve been on apixaban for a number of years now and so far not been asked to change.
However my 92 year old father in law, who has chronic kidney problems, has just been given edoxaban instead of his usual apixaban on the premise that the apixaban was not available.
In a quest to find out if the drug was actually in short supply, I discovered this article:
My mother has been on Wafarin for many years. The GP asked her last year if she wanted to go onto a DOAC instead - she didn’t as she is very stable on Wafarin.
She now has a ‘review’ with the practice pharmacist next week - the first in 10 years. I have requested a telephone review for her due to mum’s poor mobility but mum said she had a call from the surgery yesterday to say the pharmacist is insistent that mum needs to attend in person. Looks like I know why now, having read the article. I’ll be ringing them on Monday for an explanation!
Thank you very much for posting, very useful for us to bookmark and keep to take to GP surgery.
Very disturbing. I also wonder about Apixaban availability as I was able to only fulfil 50% of my prescription this month.
When I attended a regular neurology appointment a Consultant Pharmacist sat in on the appointment and I was asked to reduce my drug regime as I was stable. It seems clear that there is a big push to reduce the pharmaceutical bill in all areas.
Debatable. Working out of whether this is purely clinical decision or cost cutting measure wasn’t made clear so is a bit disconcerting. So far I’ve tolerated them very well. One of the drugs is, I know, is very expensive - like x10 cost of anticoagulants.
Case of suck it and see by reducing very, very slowly ie: over next 6 months. Because I’ve been on these 2 medications for 9 years now, the risks of side effects which include developing numerous cancers, renal/liver failure, high risk of serious infection, diabetes, increased risk of bleeds etc etc is now rising so the risk:benefit ratio changes. Alternatives are steroids for life - increasing osteoporosis, heart problems or older biologicals or chemotherapy type drugs. Rock and hard place come to mind.
That's a dreadful place to be in. And one in which any pressure due to the financial considerations of being " an expensive patient" can only make things worse. I did see an item I tnink on Channel 4 news recently about the NHS wanting to reduce it's drugs bill. The recent fall in the pound not helping.
I’ve been asked to change from Rivoraxaban which I’ve been on for 10 years to Edoxaban by the surgery pharmacist, because it’s cheaper she said! I’ve been taking it for three weeks. The pharmacist has rung me twice to see how I am. Not quite sure what changes she was expecting… but I’ve been fine!
It may also be noteworthy as that this may be a result of a sweetener to the UK government by the US in attempting to influence trade deals with US - Edoxaban is a product of Daiichi Sankyo (US company with Japanese parent company) whilst Apixaban API has an Indian parent company and Pradaxa - German. With the falling value of the £ this will have an enormous impact on the cost of imports so anything the government can do to reduce NHS cost furtively - they will.
I would much rather pay a contribution toward the cost than risk changing, so far I haven’t been asked to change - the answer will be absolutely not!
It is the ‘furtively’ aspect of all this which really troubles me. I am very concerned about my father in law because his kidneys are in a very poor state.
When I first started on apixaban I had a number of side effects that I had to ‘power through’ and my understanding is that it is the best of the DOACs!
As I am still in the blanking period following an ablation (and I’ve dropped the bisoprolol) I don’t think I’ll be approached about switching anytime soon but should it happen in the future I’ll be prepared!
Like you, I’d be prepared to pay towards the cost.
I’m interested in your comment re Apixaban side effects that you ‘powered through’
I changed from Rivaroxaban because of having to have a substantial meal with it, which wasn’t always convenient. I’ve been on Apixaban for approximately eight weeks, have had headaches, dizziness which have reduced but now have slight heartburn. How long did it take for you to feel ok.
I was very reluctant to take an anticoagulant at all but gave in because of the stroke risk. I knew apixaban was the best one but have to confess to rushing to speak to a pharmacist when I read the small print in my first pack as I had visions of bleeding from every orifice!
My symptoms were headaches, dizzy/spaced out feelings, bruising (which doesn’t go away) and I had some neuropathy in toes and fingers. After a couple of months of this my GP offered to switch me to a different DOAC but I knew that a different one would bring its own set of symptoms so persevered with apixaban. Apart from the unwanted bruising, everything settled after about three months…. So try to hang in there!
No doubt, like me you have been worried about bleeding risks. Last year I tripped over the garden hose and bashed my head on a concrete patio. There was a bit of bleeding but it was grazing rather than a serious cut. An egg shaped lump appeared on my forehead like I was growing a unicorn horn and a couple of days later I had black eyes develop. When I asked in the pharmacy about something for the bruising I was told to see consult a Dr asap. The GP advised to go straight to A&E for a scan as the bruising around the eyes could indicate a brain bleed.! I was assessed quickly and thoroughly in A&E & the results of the scan were absolutely fine. I’m just flagging this up as a reminder that any head injuries should be checked out just in case…..
Thank you for the article, Suze. It was very interesting. Yesterday I collected my prescription and for the first time in 3 years the pharmacy was short of 30 tablets of Apixaban. I need to speak to my gp as I'm 78 and a quarter, weigh 8st 4lbs which is a stone lighter than when I first started taking it. It would save money therefore for me to switch to 2.5mg of the med. I tried a year ago as I feel sick and slightly anaemic on 5mg but they wouldn't have it as my kidneys are apparently excellent!!
Curiously, I think the smaller dose costs more! I think the policy is to switch from 5mg to 2.5mg at 80 but looking at your weight you may well be over medicated. Earlier this year, after some weight loss, I was struggling with various symptoms and my GP decided I was over medicated with bisoprolol and instructed me to halve the dose. Thankfully, following an ablation, I have stopped it altogether. Now I’m only taking apixaban and I don’t want any interference with that.
Camelia. I am the same age as you and also 8st 4lb with excellent kidney function. I have PAF, episodes average one every 6 months. My consultant wanted me to take 5mg ,I asked if I could take the 2.5mg as my Dad died from a bleed on the brain and I felt very nervous about a full dose. He said anything is better than nothing and agreed. It is a worry when your so small.
Thanks for the heads up! I've read the article you posted and am now armed with some info if I get a call advising a change. I don't care for the fact that there is currently no antidote to Edoxaban so if you get a bleed, what happens then?
I'll be sticking to my guns as Apixaban has been fine for me and I see no medical reason to change.
I hope no one is adversely affected if they are forced to change.
When I started anticoagulants 6 years ago, (Rivaroxaban then Apixaban) I was told there was no antidote but there was something they were able to do a certain procedure if someone had a major bleed........ mot quite sure what other than a blood transfusion.
It's particularly timely for me as, after an AF journey of 23 months and 12 events, I have my "first ever" appointment at an Anticoagulation Clinic on Monday at a large London hospital.
The article mentions it might be easier to prescribe Edoxaban to new patients rather than trying to switch those patients already on other anticoagulants. I suppose as one of those "new patients", I might well be one of the targets of this new Edoxaban regime.
Obviously now I will listen to their recommended first choice anticoagulant with more awareness of possible conflicts of interest in their choice. And I'll have more questions too.
As I also have concerns about previous chronic bilateral subdural haematomas, the non-existence of an authorised reversal agent for Edoxaban is knowledge I also appreciate going into my appointment. My history, along with the lack of reversal agent, would seem to make Edixaban the least suitable of all DOACs for me, regardless of cost.
Knowledge is power, and your Post has served the Forum exceedingly well.
I hope all Forum members are made aware of this article to help empower their ongoing communications with medical staff.
I've had my anticoagulation clinic appointment this afternoon at a major London Hospital. I discussed my situation with a "pharmacist". Their recommendation was that I start an anticoagulant, Apixaban.
However I learned that there had been a lot of back and forth discussions between Cardiology, EP, Neurology and Haematology about my previous brain bleed before that decision was finalised. Good to know, but sadly I wasn't involved in any of these discussions, so I am no wiser about the risks estimated for me individually going forward.
With a chadsvac score of 2 for my age, and no comorbidities, Apixaban was recommended "because studies showed it produced less brain bleeds than other DOACs", and so was most suited to my situation. Good to know my medical history played a part in their recommendation. I'm thankful for that.
However I learned all new patients are being offered Edoxaban as a first choice, as was indicated in the article. Seems like the above 'brain bleed" statistics are not so important for mos t new patients. Doh!
Thankfully, the Anticoagulation team accepted my decision not to start any anticoagulation because of the risks as I calculated them for myself in my circumstances, and living alone. Additionally I am still in the process of trying to restore some level of normality to my abysmal Vitamin D level of 22 mmol/L. Such a dangerously low level of Vitamin D is repeatedly suggested as a potential source of arrhythmias, and before starting new lifelong medications I want to resolve the Vitamin D influence as best as possible.
Sounds like that went well and good to hear you were offered apixaban. If you can avoid that too even better as it is daunting to feel it’s a lifelong medication. Good luck with sorting the vitamin D.
I just got a letter yesterday stating my surgery were changing my anticoagulant from Apixaban to Edoxaban. It mentions cost cutting. Whilst I appreciate the dire need to be as economical as possible I am concerned that cost cutting is trumping safety and efficacy. I would like more information on the differences between the two drugs. I had my ablation in September so would also prefer to wait for my arythmia team review before changing any meds. Asit happens I am due my annual GP review this week with the gp nurse, so will definitely raise the subject then.
I am shocked that they are trying to interfere with your meds while you are still in recovery from the ablation!
As far as I am aware, unless there have been recent developments, edoxaban does not have an antidote and it is also harsher on the kidneys. I researched all this when my 92 year old father in law, who is in late stage kidney failure, was switched from apixaban to edoxaban. We made very strong objections and he is staying on apixaban.
If I were you I would definitely resist this change, especially in the light of your recent ablation.
I've just phoned the nurse leading the review/change . After some discussion she agreed to keep my prescription as apixaban. Result! I will discuss meds when I have my post ablation 3 month review. Thanks for your support.
That's good news. I think all of us on apixaban are going to have to 'fight our corner' at some point.Glad you stood your ground and hope the ablation has been successful for you.
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