I think I have had AF for many years but always put it down to panic attacks. Episodes were becoming more frequent but didn’t last long., eventually saw my GP. It has taken over a year of usual tests with no face to face consultations. I have finally been diagnosed and informed over the phone. that I have AF & Atrial Flutter. Have been put on the list to see an EP but have been told there is a long wait. Been taking Bisophorol & Edoxaban for a few months now. Initial blood test but no review or discussion about this. I am feeling very alone and anxious. Using forums and Google to get information. I am feeling that I would prefer to be taking Apixaban rather than Edoxaban as apparently there is no antidote for Edoxaban if you do have a severe bleed. Very worrying . I would be grateful for peoples thoughts ? Can I request a change through my GP ?
Many thanks in advance 🙏
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Joker34
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There is no antidote for any of the anticoagulants although apixaban has what is called a reversal agent. To be honest this a a bit of a nonsense really as most minor injuries respond perfectly to normal first aid treatements such as pressure. Any injury serious enough to need more would likely be castastrophic anyway.
Like many people, I have ben taking an anticoagulant for about twenty years (warfarin) and have never changed my life style or wrapped myself in cotton wool. I work with tools and machinery, do DIY, gardening and build engines for racing cars and to date have never needed any special treatment.
I firmly believe that one reason people are so scared of anticoagulants is the increasing missuse of the term blood thinners which seems to have become currency over the last fifteen years or so making people think that their blood is actually thinned and may leak out more easily. It isn't and it won't.
Regarding the pros and cons of edoxaban and apixaban, the former has cost benefits to the NHS and the latter may be slightly safer for those over eighty years of age.
I think the main reason people are "scared" of anticoagulants (AC) is because there are risks associated with taking them. You can't make informed decision about their use without understanding this. Your doctor would also be remiss in their duty if they did not explain that when they are prescribed for you.
However, if you're put on AC's it's because they reduce your overall risk of having a medical episode. That's good thing IMO - and that's the way it should be explained.
I'm not on AC (CHA2DS2-VASc score = 0) but more than happy to start taking AC when the balance of risk shifts in their favour.
Just passing on a comment from an experience I had the other day. I attended for blood tests on Friday with my Surgery Nurse ( who also is my Surgery INR nurse ) - I asked her what the bloods were for - she said that as I was now on Edoxaban surgery needed to establish for first test 'markers' since I've been on this drug.
I've known her for some years from my Warfarin days so I felt quite safe in our chat and told her I thought my GP pulled a swiftie in getting me off Warfarin ..... blah! blah! blah! She laughed and when I said I feel I've lost control of my anticoagulant status thingy she laughed even more. She said I had no need to worry. Its quite Okay ........ BUT then added. If I were taken to A & E by ambulance and were detained for treatment/whatever you wouldn't get a choice and they would switch you to a NOAC (Edoxaban) with no discussion ...... just advice on discharge on how to deal with Edoxaban.
I'm still doubtful even so, so just make the comment to you as an aside. It still feels unnatural not doing INR testing. Matter of interest I also reminded her that this surgery had never given me a PSA blood test in the decade I'd been with them. Her jaw dropped .... click, click, click went her computer keyboard ... then came Oh! Oh! Oh! I reminded her that I was taking Finasteride for my prostate. She agreed to use the then given blood draw and get a PSA done too. So far I have no symptoms, other than from old age. 😂😂😂😂
That last bit is appaling! PSA tests saved my life as you know. I was 66 when diagnosed though PSA had been rising steadily for five years and no I didn't have any of the typical symptoms .
Dear Bob - in normal circumstances I would entirely agree with you. I have been on Apixaban for at least 8 years now without signicant issues apart from fairly regular gum bleeds at night, I was advised this was fairly common by my surgery despite practicing good dental hygiene
Hoewever, just before Christmas I experienced extremely severe bleeding at the wrong end and ended up in hospital for five weeks. CT scans and other investigations , including a camera, revealed a stone as the possible culprit but the general consensus was that it was exacerbated by the Apixaban. Indeed when they restarted it, it bled again. Now at home recuperating having lost well over a stone - I also had 2 blood transfusions. It’s complicated as I have stage 3 HR and permenant AF. I’m awaiting an MRI scan to determine the type of device I will get - it was all approved last year.
The upshot is I’m currently off Apixaban and am awaiting advice from the cardio team as to when to re start and at what strength - I’m 76 so it’s possible it might b e at a reduced dose - the last thing I want is a stroke but at the same time its fairly obvious I’m now a high bleed risk - catch 22 springs to mind.
I'm scared of anticoagulants because my grandmother died from a massive hemorrhagic stroke and my father and his siblings always remarked on how very much I resembled their mother. Nobody in my family has had an ischemic stroke. Also as terrible as ischemic stroke can be, people often recover; hemorrhagic stroke, much less so. So, I take the steps I can to lower my stroke risk such as daily exercise, eating a whole food plant based diet, and reducing stress.
Same here ,one problem now is that there is an out of stock issue off the 100 mg I was prescribed 200 mg that I have to split in order to take the 100 mg. I don’t want to be told to take something else .. but worrying to me.
May I suggest you get a second opinion and consult your Surgery Pharmacist ( if it has one ) or a large Pharmacist in your local shopping centre/ or somewhere nearby and ask exactly the same question. A Pharmacist (not Google) is probably more knowledgeable and more qualified to comment on the appropriateness of these drugs for you than a GP and to discuss the pros and cons of Apixaban v Edoxaban.
As an aside I went onto Warfarin at the age of 65 in January 2010 and stayed on it until November 2023 when my GP moved me onto Edoxaban because it has a lower bleed risk than Warfarin or other A/c's. The reason for this was that she wanted to shift me onto a higher potency pain relief to deal with the pain from a torn Shoulder Rotator Cuff tendon. I agreed only because I wanted anything for pain relief ! Were it not so I would be more than happy to stay on Warfarin.
Other wise I agree with BobD and in fact at 79, I still have a part time job, 30 hrs a week driving a double decker bus for a major national bus operator who has a need for drivers on a local major College contract. Not quite the same risks as Bob describes with his activities but still something of a challenge at times.
This is something that worries, me, too, and I'm sure we are not alone in our fears. I suppose it is a bit flippant to say it, but, of course, there is no antidote to a stroke, either.
I was surprised, and pleased, to read, though, a while back, that the usual treatment for internal bleeding worsened by an anticoagulant isn't an "antidote" (or "reversal agent") at all, but a blood transfusion which dilutes the tablet's effects sufficiently to allow any bleeding to be controlled medically or naturally. There are other techniques to remove the agent from the blood stream, too, not requiring the reversal agent. Apparently these are long standing medical routines. Of course, severe internal bleeding can be a medical emergency, not least since it can be hard to diagnose in time. We do need to be careful and, perhaps, not go climbing ladders, I guess!
Out of interest, edoxaban has, I gather from a German study, recently been shown to be the equal of apixaban in terms of its effect on stroke reduction and other useful parameters but it is more convenient owing to its once-a-day dosage.
I suspect we have no option but the one we are offered and should be grateful for that.
I presume you had an ECG to show you had atrial flutter as well as AF? That must have been face-to-face, at least. These phone appointments ought to be made illegal. What you will soon be given, I imagine, is an echo-cardiogram to check the structure of the heart is sound. I gather a good deal of information can be extracted from a well carried out ECG, however.
I think you will find that the German research you obliquely mentioned showed Edoxaban, when compared to all other DOACs and Warfarin, as having the lowest risk results for strokes, and equal lowest risk results for major bleeding. The report doesn't seem to address minor bleed risks (although I appreciate such bleeds are of major significance to some users of anticoagulants).
However, my Reply comes with the following advised "Warning from Admin: If anyone has any questions regarding the article and how it may apply to them to please speak with their doctor or healthcare professional for advice"
That was the one. I didn’t look it up, so my comments were from memory. The trial patient numbers were not that large given the very low incidence of the effects studied and the edoxaban patient numbers were significantly lower.
I might yet be switching to edoxaban as the once daily dosage is appealing,
I have been on Edoxaban for over a year and initially had same worries about reversal agents. However two bangs on the head later, don’t bruise anymore than I did before, am in the process of pruning my 100+ roses who are ungrateful and fight back resulting in only pin pricks of blood. I have stopped worrying about it. As Bob says it would only be an issue in a situation which was likely to be catastrophic anyway and they don’t come along every day
Hi, I was switched from apixaban to Edoxaban because the surgery pharmacist said edoxaban is a safer drug. He said if you miss a dose of apixaban, the chances of having a stroke increase significantly. Edoxaban is once a day rather than twice, and stays in the system longer so is less likely to result in a stroke if you miss a dose. Hope that helps.
It’s very concerning to hear if you miss one dose of apixaban the chances of having a stroke increase significantly. I’d really like a reference to that if anyone has more information.
I’ve had to stop apixaban for 36 hours before a colonoscopy and my cardiologist was quite happy with that. Also had a fracture and had to wait for 24 hours+ before they could operate. Presumably if Edoxaban stays in the system longer I’d have had to wait even longer which wouldn’t have helped the fracture.
I think I would want to dig a bit deeper on that advice as well. I have several surgical interventions and 2 fractures and did not stop Apixaban until the morning of the procedure so I missed only one dose and was told they would bridge with Heparin, if required.
I recently had a colonoscopy. The consultants records still said I was on apixaban even though I had told him I was on edoxaban. I was told to keep taking the apixaban when I received the letter with the laxative instructions. I rang the department and spoke to a nurse and explained I was actually on edoxaban. She said to carry on taking it. However during the colonoscopy, when I told the gastroenterologist I was on edoxaban, she said she could not remove the polyps she had found and I should have been told to stop edoxaban for 3 days. I've got to go back in a couple of weeks and go through it all again, this time stopping edoxaban for 3 days before.
When I had a biopsy for GCA I was on apixaban. They said I didn't need to stop taking it, and it was fine, even though they were dissecting a small artery!
Up until a year or so ago, Apixaban was only available in its branded form of Eliquis which apparently was/is expensive in comparison to Edoxaban. There were quite a few posts here at the time that patients were being asked or some even said persuaded to change. Then came the generic unbranded versions of Apixaban and I’ve not heard much more about it since. I’ve been on Apixaban for 3 years but the last year or so have not received branded Eliquis once, just generic versions.
Have a look at some of the Related posts on the right of the page (bottom on mobile) or do a search to see previous posts.
Been on Edoxaban for over 4 years after a stroke which after investigation revealed Afib. I've had a couple of tooth extractions , molars and no issues with excessive bleeding. I have had the usual knocks and bumps and no issues there either. I was very fortunate that my stroke was thrombolised with no after effects, might not have been so lucky if it happened again. Whatever the anti coagulant prescribed it's better than having a stroke
if your GP initially prescribed edoxaban ,as normally it is sn EP, then I can’t see why he can’t change you to apixaban. Apixaban does have a reversal, but I was told it is also kinder to the stomach snd brain
I do know that when I had a very nasty fall hitting my head so hard on paving I had a brain haemorrhage snd they gave me the reversal or the antidote and I was fine thsnk goidness
I looked online at various UK Health Authority directives, and while Andexanet alfa is approved for reversing anticoagulation from apixaban and rivaroxaban, it is also used off-label for reversing edoxaban.
I hope that helps. Please read the safety and risk profile of Edoxaban as tabulated in the German research I quoted in my Reply to Ppiman above.
Welcome to the Forum I am sure all the Members here will make you feel welcome and offer their own advice based upon their own experiences. Please visit the AF Association webpage; heartrhythmalliance.org/afa/uk where you will find a wealth of informative videos, resources and information. However, may I suggest contacting the Patient Services Team that are here to offer support and advice; heartrhythmalliance.org/afa...
Just did a little more research and both have same half life (12 to 14 hours).I am on apixaban for 5 years and have been told to stop 3 days before any infections or procedures (haven't had any surgeries).
It also indicated apixaban best for stroke prevention and edoxaban for bleeding.
But always consult a specialist in your situation before coming to any conclusion.
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