Edoxaban to Apixaban.

[Myflowers2]

Has anyone changed from Edoxaban to Apixaban . Because Edoxaban doesn't have an antidote for a brain bleed.

[BobD Volunteer]

Bit of non event that since reversal agents (they are not antidotes in the true sense) may only be available in hospital so damage already done. Apixaban does have a very good profile regarding intercranial bleeds especially for the elderly. I may switch from my old faithful warfarin to apixaban in a years time when (if) I make 80.

[mjames1 in reply to BobD]

Bit of non event that since reversal agents (they are not antidotes in the true sense) may only be available in hospital so damage already done.

Sorry, the "damage" can be mitigated by a reversal agent -- after the fact in a hospital -- which can potentially stop someone from bleeding out. How can you call this a "non event".

Jim

[mjames1]

Excellent question. Years ago, when I was taking Xarelto, there was also no official reversal agent, however my ep assured me that there were a number of drugs widely available that would work if needed. You might therefore pose that question to your ep. If it turns out that Edoxaban cannot be reversed, or if the reversal agents are not as effective, or as widely available as with other thinners -- then I would be asked to be switched off of it.

Jim

[Countrydweller2 in reply to mjames1]

Hi James, just wondering why you changed from Xarelto, and what you changed to?

[mjames1 in reply to Countrydweller2]

I asked my ep to switch me to Eliquis based on some minor urinary tract bleeding and also some positive things I read about Eliquis versus other NOAC's. My theory is that the 2x/day dosing versus 1x/day with Xarelto, gives a more even drug delivery, but just my theory. Currently only taking thinners on an "as needed" basis, dependent on my afib status.

Jim

[Countrydweller2 in reply to mjames1]

Thank you! All the meds make me ill so I have tried taking 1/2 twice daily, or leaving them off altogether for days so I can get back to living. The doctors are not happy with either but I read here about someone only taking Eliquis when in afib. Touch wood I don't have bouts too often and I've taken Eliquis for at least a week after one, but I have had strokes. 🙄

[mjames1 in reply to Countrydweller2]

With a history of strokes, you have to be doubly cautious, which is probably why the doctors aren't happy with you cutting down your eliquis or leaving them out altogether. It's beyond the pay grade of anyone here to advise you on this, but a second medical opinion is always a good idea when you and your doctor are at odds.

Jim

[mjames1 in reply to Countrydweller2]

I'll just add to my earlier reply, that if you're truly at high risk for strokes and cannot tolerate any of the NOAC's or Warafin, then you may be a very good candidate for the Watchman Procedure, or similar. That would allow you to go off thinners entirely, with the exception of daily baby aspirin, and still help protect you from strokes.

Jim

[Countrydweller2 in reply to mjames1]

Thank you, Jim. When I saw a private cardiologist he just told me to continue with the Xarelto I was on at the time. I told him a friend of mine had a stroke while taking Xarelto. He said “Strokes, strokes! Some people just get strokes.... Xarelto, Eliquis, it’s all the same. Keep taking the Xarelto.” So!

I’ve read Xarelto causes more bleeds but not sure of the stroke comparison.

[pusillanimous]

I was on Xarelto and then on its generic iXarolo quite happily (1 pill a day at 5pm with my last meal of the day) - then I read that Eliquis was better for A fib and asked my doctor to change it. As I'm a bit OCD it had to be exactly 12 hours apart, so I was taking the second one at 5am without food as allowed. I took it for 3 months and was getting the most dreadful heartburn . Have gone back to iXarolo as according to the reports the difference is very slight, no problem, one tablet always food, no heartburn. To each his own !

[Countrydweller2 in reply to pusillanimous]

Interesting! I keep changing from one to another. What was the difference you saw between Xarelto and Eliquis please?

[pusillanimous in reply to Countrydweller2]

Definitely no heartburn with Xarelto and the convenience of one pill per day. Neither caused problems such as tummy upsets.

[Dudtbin]

i was reading somewhere that they do have reversal agent for all of the anticoagulants but I can’t remember exactly what it said or where i read it. Might have been in the British heart foundation magazine.

[ozziebob]

I would also like a definitive answer to the repeated statement that "edoxaban doesn't have a reversal agent".

I am confused because, after doing my own research re the UK situation, I understand that andexanet alfa is an authorised reversal agent for apixaban and rivaroxaban, but that it is also used "off label" for edoxaban.

Further, I cannot believe that so many UK patients are being offered edoxaban as a "first choice" anticoagulant if there is no reversal agent.

So, if there are medical professionals reading this who can add some measure of "meaningful understanding" to this situation, I would be very grateful for their contributions.

PS. Having previously suffered unexplained chronic bilateral subdural haematomas, a definitive answer to this question is a matter of "life and death" to me.

[Tykelady]

I have been on Edoxaban since last July and after a recent stay in hospital it was found that the 60mg was double the dose I needed because my height and weight had not been taken into account.

[Sixtychick in reply to Tykelady]

When I was prescribed 60mg of Edoxaban, I looked it up on the internet and found that I had been given too high a dose, for my age and weight, so I rang the GP and told them, I thought I should be on a lower dose and they agreed and put me on 30mg.The GP’s don’t always check properly. I always check on the internet, when I’m prescribed something new, before I take it.

[sunlovah in reply to Sixtychick]

What are the height/ weight nhs guidelines please?

[Sixtychick in reply to sunlovah]

It says on the information leaflet, that if your body weight is 60 kg or under, the recommended dose is 30mg once a day. It says nothing about height.

[sunlovah in reply to Sixtychick]

Thanks

[jimlad2]

Andexanet Alfa, the reversal agent for apixaban and rivaroxaban hasn't been authorised for use with edoxaban in the UK as yet, apparently - at least not when I last checked. As a long term paroxysmal AF sufferer I asked to be put on apixaban or rivaroxaban when I turned 65, but was prescribed edoxaban instead, presumably because of cost issues (?). I argued that the absence of an authorised reversal agent justified switching from edoxaban, but the pharmacist, who seemed to have more say in the matter then the GPs at my then practice in Renfrew in Scotland, wouldn't allow it. Nearly 4 years later I'm still on edoxaban, though instead of taking the full 60mg pill daily, I take only three quarters. In the event of a serious bleed I'd hope that the staff at the local surgery, or A & E, would use Andexanet Alfa off label - if they have any available (!) - though I can't be sure they would.

[ozziebob in reply to jimlad2]

Yes, reading this article ... "Reversal agents for current and forthcoming direct oral anticoagulants" ... academic.oup.com/eurheartj/...

... does reassure me that there isn't a problem with an edoxaban reversal agent. Edoxaban is included with apixaban and rivaroxaban as using the same reversal agents, as I suggested above.

However if you only have quick access to a remote hospital, your concerns about the timely availability of the needed reversal agent remain.

Further, the latest research I have personally seen gives me confidence in edoxaban re intracranial bleeds compared to other doacs, and seems to have lower stroke risks.

We would need to interrogate your pharmacist to understand his real reasons for refusing to switch you to Apixaban. Cost or something else?

[jimlad2 in reply to ozziebob]

Cost was the only explanation that made sense to me ozziebob, but of course that wasn't made explicit. Reassurance was offered to the effect that research in the US indicated that Andexanet Alfa was effective, which of course carried no weight in the UK if its use wasn't authorised. I attempted to elicit from the practice pharmacist clear justification for the refusal to switch to apixaban or rivaroxaban but that wasn't forthcoming, which left only cost as the reasonable explanation. I used to go at such issues like a dog with a bone but I've learned that sometimes it isn't worth the time and energy. A couple of runs at it got me nowhere so I let it go. Thanks for that link, which amongst a lot of interesting stuff refers to ClinicalTrials.gov identifier: NCT03661528 that's due to be finished this year and includes edoxaban. If the result is positive then perhaps the NHS will eventually get round to authorising AA. Plus the research you mention that indicates edoxaban may have a lower stroke risk stops me from getting too wound up over it.

[ozziebob in reply to jimlad2]

Thanks for those details.

There may be more recent or accurate information available, but this is the German edoxaban research re strokes and risks that I particularly had in mind ... Lowest risk results for strokes, and equal lowest risk results for major bleeding.

pubmed.ncbi.nlm.nih.gov/347...

What's not to like?

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"

bob

[jimlad2 in reply to ozziebob]

Aye, ozziebob, looks like we haunt the same sites! It's encouraging that edoxaban appears to be slightly safer on that front . . I've reconciled myself to it these days, partially on that basis, and try to minimise the risk of bleeds - so far as that's within my power - by staying away from sharp objects and drink. Stay healthy sir.

[ozziebob in reply to jimlad2]

With my unexplained brain bleeds in the past I easily imagine all kinds of imaginary bleed risks, even straining on the toilet.🤔 If only I could avoid toilets for the rest of my life.😆

However, not having been granted any intelligent discussions about my anticoagulation concerns, and with no comorbidities (not counting an ASA (interatrial septal aneurysm)) and only a moderate AF burden, I have decided not to start the apixaban I was recommended from a distance.

What do they say about anticoagulation? ... it's a balance of risks! Indeed it is!

[jimlad2 in reply to ozziebob]

Yep . . . It's all about compromise. . Hopefully you'll manage to steer your way safely between those risks. . .

[Ppiman]

I changed from rivaroxaban to apixaban and asked about just this. Don't worry. I read that the standard procedure to treat people who are taking anti-coagulants who suffer haemorrhages does not require reversal agents but uses blood or plasma transfusions to clear the drug from the bloodstream.

Of course, this doesn't make these drugs completely safe in that respect and, in the highly unusual event of your suffering any unusual symptoms such as red, or dark tarry stools, coughing with blood, or have a bad fall that results in head injury or which might have caused some internal bleeding, then I would be dialling 999 or visiting A&E for urgent hospital investigation.

Steve

[Tapanac]

I had a really nasty fall last year and damaged my head and face as well as knees etc

Having been told that if I had a big bang on my head to go to hospital to check it out and as I thought my teeth were loose, I did eventually that day go to hospital and they did a CT scan on my head (although I said it didn’t hurt) and found a bleed (subarachnoid haemorrhage). They gave me the “reversal” drug through a cannula and told not to take my apixaban for 2 weeks and I was fine

I had originally been told by my EP that apixaban was the kindest anticoagulant for the brain and stomach.

I was originally on rivaroxaban but that kept giving me UTIs

All the best…..pat

[ozziebob in reply to Tapanac]

Ouch! 🤕

Glad it worked out OK for you.

Do you know the name of the reversal agent used? Andexanet Alfa?

[Tapanac in reply to ozziebob]

No I can’t remember what the reversal was called. I was more in discomfort with my poor face snd teeth. I truly wouldn’t have known I had a brain haemorrhage that's why any bad knock on the head should be looked into straight away.

lol

[Tapanac in reply to ozziebob]

No I don’t know. I was so shocked from the fall and broken nose etc. all I remember is that they put a drip up and cannula and about every hour came 3 times and put something in the drip

If I was in my usual frame of mind snd not shocked thst I had a little brain bleed (although I shouldn’t have been surprised as I crashed my head so heavily on the paving stones) then I would have questioned what they were doing

Sorry 😜

[sunlovah in reply to Tapanac]

And yet it contains sodium laurel sulphate (SLS) a known irritant. Edoxaban doesn't. Perhaps EP meant kinder as smaller dose..

[Tapanac in reply to sunlovah]

Im not sure why he said thst. I was on rivaroxaban to begin with, but it kept giving me UTIs do he changed me to apixaban saying it was kinder to the brain and stomach.

Take care

[1969hippy]

I did not know this. I am on edoxaban & will talk to my GP about this (if I can get an audience) thanks.

[1969hippy]

I did not know this. I am on edoxaban & will talk to my GP about this (if I can get an audience) thanks.

[Myflowers2 in reply to 1969hippy]

Let me know what they say. I'm still unsure to change even though they gave me the Apixaban.

[1969hippy]

OK but have made appointment yet.

Cheers.

[sunlovah]

Does anyone suffer muscle/ joint pain on Edoxaban especially in legs on waking?