Change from Apaxiban to Edoxaban?

Surgery rang this Saturday(!) afternoon. Asked whether I would agree to switch from to Edoxaban. Over 4 years I have not had any side effects from Apixaban nor have tests revealed any problems. Has anyone made this switch? Also, the nurse said the advantage was that I would only take one pill, instead of one in the morning and another at night. Presumably, Edoxaban remains effective for 24, rather than 12 hours with Apixaban; since there is no antidote to either drug, if bleeding occurs this will last longer.?

[Hidden]

I’m no expert on medication but having heard many who are speak about DOACs, the common view expressed is that in terms of efficacy, there is not a lot of difference between them but when pressed, many have said that Apixaban offers marginal benefits over the others. That said, some forum members express different views. For some while now, many surgeries have sought to encourage patients to swap to Edoxaban and although they may refer to single dose benefits, there is a general belief that is being offered because it’s cheaper. I take Apixaban and have done so for almost 8 yrs and it suits me fine so if my surgery tries to get me to change, I will resist purely on the basis of better the devil you know!

[Hidden in reply to Hidden]

Thanks. I too prefer to stay with Apixaban as it has given me no trouble over 4+ years.

[meadfoot]

I had the same call from GP surgery. They were completely open and said its due to cost. I refused to change from my current DOAC. Do what is best for you. If its not broken then dont be changed. Its you who will have to deal with any fall out it if it doesnt suit you. Best wishes.

[Hidden in reply to meadfoot]

Thanks. I will try to resist the change. It seems that many surgeries tout the benefit of just one tablet, but taking a morning and evening pill does not cause problems.

[Hammerboy]

I can only speak from personal experience, I have been on Edoxaban for 5 years with no ill effects . I have had minor cuts during that time and had 2 ablations without stopping the anticoagulant. Fully understand concerns about changing but it’s pretty obvious cost will come into this as the NHS is in such a state . Some of my family members work there and have seen the huge waste when it comes to prescription drugs . One delivers and collects drugs from various outlets and sackfuls of perfectly usable unopened blister packs are just thrown away daily because the NHS won’t take them back . Another spends every day calling patients to set up medication reviews with their surgery to discuss whether they still require their repeat prescription or can be changed to a cheaper but still effective medication . From what I’ve heard the level of wastage and unnecessary use of certain drugs is enormous so I guess there is bound to be concern about costs.

[Hidden in reply to Hammerboy]

Thanks. It seems that different drugs suit different people. Agree about waste and cost, but I wonder if savings feed back into NHS services or just boost the surgery income. My practice is part of a nationwide group which has some US connection.

[Hammerboy in reply to Hidden]

Thats entirely possible , I personally have no faith the NHS is run competently . It needs a total restructuring to meet the needs of patients rather than the benefit of pen pushers and career politicians

[Ppiman]

I've read only that all of the "DOAC" medicines are the equal of each other. Price is the guiding factor, overall, often.

Steve

[Hidden in reply to Ppiman]

Thanks.

[reinaway]

My GP changed me from warfarin on to a DOAC and gave me Edoxapan saying quite honestly he was choosing this because of the cost. I couldn't take it as it caused terrible stomach pains and so he changed me to Apixaban which is fine.

[Hidden in reply to reinaway]

Thanks. It seems that different people have different side effects from the same drug. Given that Apixaban causes me no trouble, I will try to stay with it.

[Hidden in reply to reinaway]

Hi,

My GP attempted to get me to change from Warfarin to a DOAC. I point blank refused. I was both blunt and terse ....... I have no issues with Warfarin - check with your INR Clinic - so there is no way on this planet am I gonna change. If it ain't broke, don't fix it.

John

[lux46]

Hi I have read on a earlier post that Apixaban is the only one with a licenced antidot in UK Also the patent for the drug has been got round in the UK and other man factories now make it so cost should not be an issue I believe

[BobD Volunteer in reply to lux46]

There are no antidotes for any of the DOACs but some do have reversal agents. (Small but important difference) .

The reality is that this is a non event. If you have an injury sufficiently serious as to require reversal then either you have been juggling with a chain saw or had some other serious accident. Normal minor injuries respond perfectly well to first aid treatment such as pressure dresssings. This is the same for all anticoagulants. After 18 years taking warfarin I can assure all that though sometimes a little messy life is fine.

[Hidden in reply to BobD]

Thanks. Apixaban has not caused any bleeding issues over recent years. I am reluctant to change if there isn't a clinical benefit. From other replies it seems that different people have different reactions to the same drug.

[Hidden in reply to lux46]

Thanks for this info.

[Kingfisher44]

I take Edoxaban and have not had any issues. However during my second ablation before Christmas I suffered a cardiac tamponade. All the blood thinners had to be reversed so I assume there must be an antidote for Edoxaban as I am still here!

[MarkS]

As Hammerboy set out above, the NHS has to reduce its bloated costs. I think Edoxaban is perfectly OK as a DOAC and unless there is a real medical necessity, people should be switched to it. If you want choice, you go private.

[phillyox in reply to MarkS]

The NHS doesn't have bloated costs - it's underfunded. Check out the data that the Financial Times has on this. The UK spends a lower proportion of GDP on health than other comparable countries.

[MarkS in reply to phillyox]

Here are the stats from the OECD: oecd-ilibrary.org/sites/e26...

In 2019, as a % of GDP, the UK is 12th out of 45 countries in the OECD. As you can see from the graph, in 2020, the UK was 2nd only behind the USA.

Just how much money are we expected to put into the NHS? It receives more funding as a % of GDP than France, but in my experience, France has a much better health system. The NHS appears poorly managed, there are too many mistakes by the admin staff, money is wasted on expensive drugs and the systems are very poor. The NHS has to be reformed so it's run for patients rather than the convenience of staff.

[ozziebob]

Drinkwater,

Here is an article that was Posted some time ago to explain the switching ...

pharmaceutical-journal.com/...

As they say, knowledge is power ...

PS. I see from your Bio that you suffered a TIA relatively recently. Now I previously suffered from bilateral chronic subdural hematomas, and as a consequence was recently recommended to take Apixaban, "because it had lower brain bleed risks", rather than the current first choice Edoxaban. I would ask your medical advisers about this re your TIA.

[Hidden in reply to ozziebob]

Interesting article thanks

[Alan_G]

I have been on Apixaban for a similar number of years and experienced no side effects or issues. If I was asked to change, I would refuse point blank. Why upset the apple cart with a new drug that might give you problems.

One of the initial reasons I chose Apixaban was because it was a 2 times a day drug. That implies it wears off quicker than a once a day drug, although I gather there are now ways in which these DOACs can quickly nullified as is the case with Warfarin.

I have another rather strange reason for staying on Apixaban. I do occasionally forget to take one. When you have them appearing as pairs in the packaging it is easy to realize when you've forgotten to take one.

[Hidden in reply to Alan_G]

My feelings exactly

[Wildare]

I changed from Apixaban to Edoxaban after a couple of months. It was a nuisance having to take Apixaban twice a day and more difficult to time doses accurately. I had also had some tummy upsets. Taking edoxaban once a day in the morning has made it easier to comply and I’ve had no additional side effects and no excess bleeds.

Hope that helps.

MP

[Hidden in reply to Wildare]

Thanks. It seems that the same drug has different effects on different people.

[javo123j]

Like many others I was asked to change from apixaban to edoxaban and was told it was due to costs. I have not noticed any difference and actually prefer taking just the one tablet a day. Down to personal preference.

[Adalaide2020]

Hi Drinkwater4.I've been on Alixaban for ... cant remember, long time. I'm fine on it whereas on Riveroxaban (if that is how it is spelt) caused me a lot of bruising. No idea why. Yes, there can be a missed dose whereas with a single dose med its easier to remember. But like a lot of folk I'm happy to stay where I am. When I started on Apixaban my chemist said it's very expensive so my cardiologist must like me! He also added I was worth it 😊.I think I would prefer to stay put.

[Roobydooby]

The pharmacist at my surgery rang me recently to say they wanted to change me from Rivaroxaban to Endoxaban, as part of a national strategy. He also admitted it was due to cost. He assured me I wouldn’t notice a difference. Hope he’s right!

[Afibflipper]

I take apixaban, I set alarms if I think I’ll forget but I actually make up my own dosette box monthly which has AM & PM sections - there is the concern people will forget but also maybe cost is an issue, also, patients whose pharmacy make up their dosette boxes will cut time by doing once a day as a pose to twice - I also heard the report that Apixaban did so more benefit over others

[Nerja2012]

It took a long time for me to be persuaded to take an anticoag simply because my Dad died in his sleep from a bleed on the brain but reluctantly I did and chose Apixaban purely because its taken twice daily, my cardiologist agreed at the time that I could take the smaller dose of 2.5mg as im only 51kg, Ive settled to take Apixaban and really wouldnt want to change.

[Engineer46]

Drinkwater,

There is no doubt that the switch to Edoxaban is purely cost-driven. Your GP surgery will receive NHS incentive fees if it starts or switches patients from Apixaban to Edoxaban and meets certain targets. While the published NHS cost of both drugs is similar at about £50 per patient per month, a manufacturer of Edoxaban offered an unpublished discount to the NHS. This is why current NHS Edoxaban users will only be given Lixiana, a brand made by Daiichi Sankyo UK Ltd, whereas NHS Apixaban users may be given brands from one of several manufacturers.

One other thing relating to NOACs generally. My GP told me that I shouldn't see much or any difference in the clotting of blood from a skin cut, as this clotting mechanism is affected by the presence of air. The clotting or coagulation of blood inside the body in the absence of air is a rather different process.

Of course, if GPs were to offer to split their incentive fees with their patients we might see more people switching!

Best wishes,

Paul

[Hidden in reply to Engineer46]

Money is all. Wonder whether savings go back into services or into the practice pockets.

[Hylda2]

I take Dabigatran and was asked would I switch. Said I would discuss with consultant. Only one a day they said!! As I take a statin in the evening that’s no problem

[Jmbrph]

Listen to Dr Peter Noseworthy from Mayo compare DOACs on YouTube.

[Hidden in reply to Jmbrph]

Thanks

[Pleb27]

don’t do it it’s all down to cost did it 3 years ago affected me they had to change back to Apixaban

[Hidden in reply to Pleb27]

Thanks. I will resist the change.