Although not so much recently, but there have been a number of posts from members about GP surgeries in the UK encouraging their patients to change from Apixaban to Edoxaban. It would be interesting to know the outcome from those who resisted the change. The reason for asking is that I have received a blanket message from my surgery asking me to attend a health review for a whole variety of different conditions but the only one that applies to me is a DOAC medication review. On the basis that most surgeries at the moment sadly don’t seem to know if it’s Tuesday or Bank Holiday Monday, I’ve chosen to ignore and wait to see if they contact me again.
It would also help to know the outcomes from those who agreed to make the change.
I was offered Endoxaban by the pharmacist at my surgery. When I looked further into it I was told they can treat 2 people for the price of Endoxaban and only one for the price of Apixaban. So it’s really about the money. I declined as have been fine to date on Apixaban.
I have not been asked to change from apixaban but have noticed that on collecting my repeat prescription, I do not have eliquis but sandoz apixaban, which I assume is a generic ( therefore cheaper! ) version.
My experience was that I was sent a letter telling me that my apixaban would be replaced with Edoxaban. I accepted this.
Any medication change seems to bring on af episodes for me and that’s what happened. I had more af for the first few days shortly after I had taken the edoxaban, until eventually it settled down. I think I’m used to it now.
I discussed this with my GP who, of course, said the additional af couldn’t possibly have been due to the meds change!
Not with those drugs but the last time I had a face to face with my GP she tried to pursuade me to come off Warfarin (Coumadin) to one of the NOAC's. I refused point blank .... arguing that I'm delighted with Warfarin, I reminded her I self test and I'm delighted with the nursing staff in the INR clinic in her surgery. If it ain't broke, don't fix it. I've heard nothing since - at all.
When I had a stroke in 2019, the consultant told me I needed to start anti coags. He gave me an option of Warfarin, a single dose tablet or a twice a day tablet (Apixaban) I said I would prefer the once a day option. He then told me Apixaban would be better because the once a day one was harder to deal with if I had a cut etc as it was a higher dose in my system at one time. I've been on Apixaban ever since and never had a problem. Therefore I will not be changing based on the consultants advice.
my mum takes rivaroxiban and dad takes dagabatran. Both were contacted by the surgery pharmacist regarding change to edoxaban, which I have always had, they just said no, they didn’t want to change their current meds snd routines and the surgery accepted that. I don’t think it’s compulsory if you really don’t want to change. Take care. 🦊x
Haven’t been asked to change as yet but noticed I was given a generic brand of apixaban - Teva - when I picked up last script. I agreed to try it but now going to ask Dr to put Eliquis on the script. Rightly or wrongly I mixed the 2 as they look very similar so I didn’t know which one I was taking, a kind of blind test. I’ve done this for about 5 weeks now. Whether it was the mixing or brand change I don’t know but I have been having stomach issues and gums have bled quite a bit when brushing teeth. It was only a couple of days ago I wondered if it was the generic brand not agreeing with me.
I should add flapjack that I do suffer from reflux/gord and have done for years and have intermittent stomach issues but they have been a lot worse these last few weeks.
The NHS spends around £17 billion a year on drugs - that is 12 % of its budget.
In 2019, the NHS spent 6.7% of its total drug expenditure on oral anticoagulants compared with 1.8% in 2015 (when most people were on warfarin). DOACs account for 61.8% of all anticoagulant prescriptions but 98% of all anticoagulant costs.
And which is the most expensive drug overall to the NHS? Apixaban.
So it's no wonder the NHS want to move people from Apixaban to cheaper alternatives. People can't remain on apixaban unless they have an excellent reason to do so. The annual cost of apixaban (£350m) would pay for 50,000 hip replacements.
Compelling argument Mark. The purpose of the post was not to influence or discourage anyone from making the change, more to establish if anyone had experienced any problems by making the change and so far, few, if any, have experienced any problems.
Mark5. You make a good point. I used to work for the NHS and I witnessed lots of waste. Every organisation must exercise prudence when spending public money. I assume that both the medications in question are equally efficacious.When various drugs have differing efficacious it comes down to clinical judgement and the patients wishes.
Yes, I was offered Apixaban, rather than Edoxaban, because of a previous brain bleed event and Apixaban was thought, by the medical "experts" at this hospital, to have lower risks of brain bleeds. But then I read some German research posted here on the Forum that concluded Edoxaban gave the lowest risk of strokes of all DOACs, and was equal lowest risk for brain bleeds. Go figure!🤔 How the patient becomes "informed" in this choice is a "tricky business".
Hi OzziebobI do agree that it is difficult to decide what constitutes informed choice. Many people have some degree of scientific training but I suspect that the majority do not. It can be difficult to decide where the weight of evidence lies.I am not a medic but I think that I can say with a degree of confidence that medicine is not an exact science. The outcomes of research are often expressed in terms of probability.
Probability itself can be counter intuitive.
I guess that every medic and treatment team do entertain the idea that they could be wrong at any one time.
Thank you for posting a rational response. To add to it, NICE have reviewed all the DOAC's and as a consequence of the NHS procuring a special contract price on Edoxaban they have a monitored programme to make additional prescribing to further impact on strokes and reduce deaths by 6500 over the next two years. For balance, to appease any sceptics, there is as yet no antidote to EDOXABAN and some (3) NHS primary care trusts have refused to adopt the new strategy because of this. But ignoring the evidence that the circumstances where an antidote might be used are extremely rare. This is an example of effective and efficient practice as far as I can see and is to be applauded.
So is the upshot of all this is that we who are on Edoxaban should be worried if you are all against changing. I have never been given a choice so have always been on Edoxaban. Is this considered to be inferior then and if so what is the downside of it.
I don’t think anyone is suggesting that Edoxaban is inferior. All drug are subject to rigorous testing so we have to assume that all DOAC’s are fit for purpose…….
A search of past posts here will show some members have said Edoxaban is preferred for reducing some risks and Apixaban for other risks eg a brain bleed. So I guess an argument can be made with your GP surgery for either dependant on you individual circumstances.
There is a NICE review on DOAC effectiveness which provides all the answers. This latest change aims to increase uptake over the next two years and reduce strokes by 20000+ and deaths by 6500. It's a positive not negative change.
I started on eliquis (the brand) in December and it was fine. I was then given the generic of apixaban and suffered really bad stomach pain and had to take omeprezole which stopped the pain. Realising it was caused by the generic I requested the brand eliquis and once again I had no pain and didn’t need omeprezole. On my recent script I was given eliquis but it was manufactured in Spain. When the stomach pains re-started I spoke to the pharmacist who said it was the brand but manufactured by a company in Spain. It costs less to buy from Spain than UK. He said it was exactly the same as the branded eliquis yet I still had the stomach pains and am now back on omeprezole. I’m going to speak to the manufacturer as I’m not convinced.
This was considered in the review but the circumstances for administering an antidote are very rare, whereas they hope by greater depth of prescribing for paroxysmal AF events to reduce deaths by 6500 over the next two years. I had an out of the blue paroxysmal severe stroke. Many ECG's and Holter ECG's failed to pick up anything other than Sinus bradycardia (40bpm) and ectopics. But my Kardia and smart watch picked up events. Also another NICE study and report advocated wider use of implanted LINQ ECG monitors. Mine was fitted in February and picked up irregularities in May. I am now exceptional pleased that my Clopidogrel has been changed to EDOXABAN. Yes there have been a few minor side effects but I am now being treated in a way that may have prevented my stroke. Hopefully others will never have to know what that event is like.
I had a punctured artery while on Eliquis, the A&E surgeon said they can manage serious bleeds while a patient is on a DOAC without a reversal agent. It is standard procedure and nothing to worry about.
All things being equal, nobody should have any issue with moving to a cheaper DOAC. Or moving from warfarin to a DOAC,
Apixaban specifically has the highest cost of any drug in 21/22 at £430m with a more than doubling of the cost.
As far as I can see, the main claim to fame of Apixaban is that users are less susceptible to GI bleeding, leading to anaemia. That is why it was prescribed for me instead of Rivaroxaban.
I had a Private appt with a cardiologist just before the appt to get me to switch from Apixaban so I asked him what he thought - turns out he also had AFib (asymptomatic) and he was also on Apixaban - His answer was he could think of no reason that would convince him to change so that was my answer - Told GP I would prefer to stay in it and GP was fine with that - Not slating Edoxaban here btw as I’m sure it’s equally viable
Hi there, I was changed from Apixaban to Edoxaban a couple of years ago due to being prescribed Multaq (Dronedarone) as for some reason Apixaban was contra indicated with Edoxaban. Have noticed no difference since the change.
I was changed to Dronedarone in the last few months. Consultant said ‘you’re not on and anticoagulant are you, to which I replied that I was, he’d obviously forgotten and said NOTHING when I said Apixaban!! I read that this drug can increase the effects of Apixaban 😳 So I half the dose.
Hello Brenda, good to hear from you, I’m doing well thank you but saw your post a day or so back, sorry to hear that you are still struggling!! Expect that gorgeous granddaughter of yours will be going to university soon!!!😂
I asked to change from rivaroxaban to apixaban but was offered edoxaban instead. However, I discussed my reasons with my GP and he was happy to switch me to apixaban., which is now also available as a cheaper generic, I gather.
Looking at the studies, there seems little objectively between the two and edoxaban has the major advantage for many of once daily dosing with or without food.
Except when it comes to doctors! Actually times have changed as age and AF have conspired to force me to avoid confrontation as it sends me into arrhythmia so easily.
I was changed from Warfarin to Edoxaban at the beg of lockdown 2020. There was no discussion about this. I was not given the choice or chance to refuse. They wanted to stop INR testing ad that was that!
I think it is more expensive than warfarin but cheaper than Apixaban.
I must say, I find it much better than forever trying to keep my INR levels stable! THAT caused me a LOT of anxiety!! Because i happen to enjoy a diet that is full of green vegetables/salad etc!!
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Changing from Warfarin to Apixaban
Edoxaban to Apixaban.
Changing from Apixaban 
Changing from Abixiban (Eliquis) to Edoxaban (Lixiana)?
