Switching blood thinners

[Myflowers2]

Help. I don't know what to do. Have the opportunity to switch from Edoxaban 60mg. To Apixaban 5mg twice. Day. What worries me is the 12 hour gap between taking the tablets. What if you forget or go over the 12 hours. Has anyone done that? Also which one is safest.

[wilsond]

It's not that critical. I have been on Apixaban for years. For dental surgery for example, I'm told to miss the morning dose, and take after the surgery,taking the evening one later.Apixaban suits me well, I understand there are more gastric problems with Edoxaban,which I can well do without!

I was told Apixaban is the anti coagulation of choice of EPs.

[Finvola]

I've been taking Apixaban for over 10 years and have taken doses late because of dental work, forgotten completely once, took two doses once - but lived to tell the tale.

I bought a pill box with 14 spaces - for each day, morning and evening - best few pounds ever spent. Apixaban is twice daily because of its shorter half life span than Edoxaban - which can be a benefit for surgery etc.

My cardiologist said it had the lowest bleed factor of any on the market - that was in 2013.

[BobD Volunteer]

Get a seven day pill box . And use it!

[Bagrat]

I too am on apixaban, and take about 12 hourly but if going out in the evening take it early rather than forget. Also have pill box system, although change of routine can still be an issue!! Must instigate phone alarms.It has the best profile for unwanted bleeds and was suggested by my cardiologist when I was having probs staying in range with warfarin.

[Coco51]

In theory I take Apixaban at 8am and 8pm. My anticoagulation nurse said if you forget the evening dose it's ok to take it up till about midnight. After that skip the dose and take the next one as usual. In fact I have an alarm on my phone and that rarely happens.

But actually I often take the morning dose at 9am. And if I'm going out to dinner or somewhere I take the evening dose early around 7pm.

I like the idea of 12 hourly doses, because IF one had a bleed, it's a shorter time till the drug is out of your system. But there are antidotes so maybe that's not an issue.

[Buzby62]

I’m officially 8am and 8pm and was quite strict with times in the beginning but now I’m a lot more relaxed with it, I may not take the morning one until after 9am now and then and the evening one depends on what I’m doing, usually on time but I’ve taken as early as 6pm if going out and after 10pm if I forgot before I went out. I think a couple of hours either way is OK but that’s an opinion I’ve developed.

There’s information sheets on both medications in the patient resources and here’s the link heartrhythmalliance.org/afa...

Best wishes

PS, I use a 7 day pill box with two slots per day, am and pm but the am,pm writing wore off a long time ago.

[Gumbie_Cat]

I completely agree with the other comments. Phone reminders and pill boxes really help. I got a pill box from Amazon - they have a huge selection. In fact mine is 7 small round boxes, in one larger container. Each day split into morning and evening. So, if I will be out during the evening I can pop one small box in my bag.

[Adalaide2020]

I've been on apixaban for years. No problem. Have forgotten a few times. Have taken a double dose once 🙄. You have a window whereby you can take the dose later or earlier. I use to be religious about my timings but all that did was stress me. I take mine 8.39am and 8.30pm but sometimes the late one is later or 30mins earlier due to going out or whatever. I keep apixaban in my bag, my van, my music case even. I do have a seven day pill organiser too. I think it's a very good medication. My pharmacist said the drs must like me , when I was put on it, because it's an expensive tablet. They have tried to put me on another one...nope not happening. I like it. I was on warfarin. Never got on with it. They couldn't get my INR right. Ever. I had blood tests a lot! But not on apixaban. No bloods. Your choice but I think they are doing you a favour. Hope it works ok for you if you change.

[pusillanimous]

I was on Xarelto for 5 years, but then I read on here that Eliquis was the drug of choice for AF. As I eat my last meal of the day at 5pm I had one pill then and as I'm a bit OCD, the second had to be exactly 12 hours later, so I set my alarm for 5am for the second. I found these pills gave me unpleasant heartburn, so I looked up the studies on the bleed factor and it was a matter of a percentage of a percentage, so I'm back with Xarelto which suits me better - one tablet, no heartburn! The rathe interesting thing, is that shortly before I changed, here in South Africa a 'generic' called iXorolo was introduced, at a much lower price than Xarelto. Everything about this pill was the same as the original, from Bayer's address in Germany to the shape and colour of the tablet, the only difference being the name on the box. Now I have gone back to iXorolo, I find that the price has shot up - it's more expensive than Eliquis. Bayer has obviously changed its mind about being kind to poor Africans !!!!!!!!

[Domino49]

Been taking Apixaban for 3 years. No problems. Up until recently had blood tests every 6 months. At review this has now been changed to every 12 months. At start of taking Apixaban pharmacist said if ever I forgot I had a 7 hour window to take it. I have to say I’m regularly and hour over. Tend to take it at 10 am and 11 pm at bedtime. Not suggesting you follow my routine though!

[Singingforever]

I have been on Rivaroxaban fir about 6 years, but GP has just changed me to edoxaban because it is cheaper for the NHS. I do not mind that as long as it works as well with no side effects - so far, so good.

[Broseley]

Go with it. I've noticed no difference. I swapped the other way round.

I don't put my pills in boxes, they don't make one big enough. I actually found an advantage with the 2 apixaban: if I missed one, it was obvious from the packet as there would be one left where there shouldn't be.

[Buzby62 in reply to Broseley]

I think the packet layouts of pills is a whole new subject in itself, I remember the branded eliquis strips of 2 rows you speak of (simple) but we rarely get them now in UK since the generic Apixaban and the layouts vary from brand to brand and within brand.

[Broseley in reply to Buzby62]

True, but they still come in two rows, so I took one from each side, 2 daily. I only swapped last April.

[Buzby62 in reply to Broseley]

Some might but I haven’t had them. Usually get 3 rows of 5 these days with one blank in the middle. It makes sense to someone I guess.

I don’t find it an issue as I fill my box once a week, but it can be for some, especially when you have lots of different ones.

[Lupaal]

I've been on apixaban for 4 years, I set the alarm on my phone for 8 am and 8 pm so get a reminder. I do occasionally take the evening one a bit earlier if going out but it works well most of the time.

[Tapanac]

I’ve just been talking to another on this forum and telling that my EP changed me from rivaroxaban to apixaban not only because rivaroxaban gave me UTIs but that his words were apixaban was kinder to the brain and stomach

As far as the 12 hour gap yes I try to take mine between 8.30-9.30 morning and night, but many times I have been unable to keep to thst and all seems ok. 🤞🤞🤞 Also occasions where I have had to have some sort of procedure and had to stop for a number of days snd again ok 🤞🤞

If you think about it a pill you take every 24 hours would be the same if you forgot etc

All the best… pat

[Ppiman]

Yes, and you will remain safe. I am thinking of switching to edoxaban from apixaban since it’s cheaper for the NHS, is taken once a day, and works as well.

Steve

[Fastbeat1 in reply to Ppiman]

Me too

Edoxaban far better in so many ways !

[Hidden]

I refer Edoxaban as if I had to remember one at night- when I take it with the rest of the cocktail- AND one in the day I’d be regularly forgetting it !

[Jetcat]

iv been told I have to take lanzoprolol with apixaban because it can cause stomach issues.!!!

I’m waiting to hear from cardiologist to see if there’s another anticoagulant I can use without the need to take another drug with it.!

[ozziebob]

Can you please elaborate on the "opportunity" that has provided you with a choice between your current edoxaban and a possible switch to apixaban? Most of us aren't offered such an alternative except for medical reasons, which doesn't seem to be your situation? 🤔

Just asking to understand better whether I have anything useful to contribute to your Post.

[Myflowers2 in reply to ozziebob]

Purely because it has a reversing agent and a 12 hour life . My doctor said if she had to go on a blood thinner she would use Apixaban over Edoxaban.

[ozziebob in reply to Myflowers2]

Thanks for getting back to me.

Your answer is interesting. The question of which anticoagulant is best seems to me to be a constantly changing world of conflicting research and opinions, and is always best decided by each patient's unique health circumstances.

Previous research I have undertaken has revealed to me that while edoxaban doesn't have a "approved" reversal agent like apixaban and rivaroxaban, the same medication is used "off label" for edoxaban. But then this approval for DOACs seems to be restricted to gastrointestinal bleeds, and when it comes to intracranial bleeds all treatment offered re DOACs is as part of ongoing "trials". I will need to do more research on this because it's definitely of concern to me as well.

Forum members offer both positive and negative experiences with both apixaban and edoxaban, although there does seem to be a weight of opinion favouring apixaban. However my thoughts are still not finalised either way, especially when I am presented with this German research which gives equal or better results for Edoxaban over other DOACs and Warfarin. Lowest risk results for strokes, and equal lowest risk results for major bleeding (intracranial).

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

It's worth reading the short research summary and conclusions available, although you still have your "doctor's' opinion to consider.

Good luck going forward. Perhaps best to do some research of your own, if that is a possibility for you.

bob

[dizzielizzie1]

Hi, I started off with Rivaroxaban, but did a bit of research and found out that Apixaban was better for people with stomach problems. I asked my GP if I could change over and he said OK so I have been on it for 8 years now. I have to say that that I am a bit lazy about taking the evening tablet exactly on time , but so far have suffered no ill effects. I would say if you want to change over to Apixaban go ahead.

[Hampden]

I set my phone alarm for twice a day. I tweak the alarms if I’m leaving early. I’d forgotten to take once or twice before that but didn’t worry.