As a relatively fit nearly 60 year old, I'm looking forward to getting out on my bike as spring approaches but I'm worried about having an accident and suffering an intercranial heamhorrage or other internal or external bleed.I've read about athletes timing their DOAC dose to minimise this risk and using Apixaban as this is a twice daily pill that clears the system after 12 hours rather than Edoxaban which is a once a day pill that takes 24 hours to clear the system.
The idea is to delay taking the morning dose of Apixaban until I return from my ride.
Has anyone here got experience of this approach?
I have Drs appointment in a week or so to discuss this and I'm aware that Apixaban is more costly than Edoxaban so I'm expecting some resistance.
Written by
MisterMagoo
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I have not experienced any extra or more bleeding with apixaban. I go to the gym cycle garden and am not more careful than I used to be - falling over etc - I should be i know and I think I was when I first started the tablets nearly 8 years ago. If I do bleed more it is minimal and if I do bleed longer again it is minimal too as I definitely don't notice. I even bought special wound powder - which was expensive and have used none of it - it is now out of date! I do notice I bruise easier but that is all. Talk to your Doc or pharmacist if you are thinking of changing times of dosage as it is important not to take the second dose either too early or too late. Definitely discuss this with your Doc or better still cardiac nurses.
Be careful when you go out on your bicycle - it's h**l out there!
As a mountain biker who was on Eliquis around the time of my ablation, the issue isn't bleeding in general - it is hitting your head or helmet hard enough to cause a brain bleed. So, I think original poster's concern is well founded. My experience with docs is they can't understand/quantify this bleed risk - only your stroke risk. All the DOAC studies focus on the general population vs some subpopulation where bleed risk may be more concern than stroke risk, especially if Chadsvasc scores is very low.
If you don't mind me asking, why are you taking anticoagulants at 59? Do you know what your CHADSVasc2 score is?
Now your TIA is a different issue from the brain/major bleed I suffered (unexplained bilateral chronic subdural haematomas in 2016), but I do understand your concerns.
Subsequently, after my pAF was diagnosed in early 2022 (prob started late 2020), my local hospital Haematology, because of this history, recommended a prescription for apixaban rather than the then first choice edoxaban.
However, while I am 77 with Chads2 of 1, I haven't yet started any anticoagulation because of my fears that, living alone, a repeat bleed while I was anticoagulated might well prove catastrophic before I could call for help. A not unreasonable fear according to some medical opinions I have read.
However, I have subsequently read very positive research findings and personal experiences re edoxaban, such as this German research ...
Lowest risk results for strokes, and equal lowest risk results for major bleeding (that's brain bleeds). Assuming their are no conflicts of interests in the authors, that's impressive results to me.
But it still leaves the issue of dosing either once or twice a day as a difference between edoxaban and apixaban to worry about concerning a future possible major (brain) bleed (caused either by accident or spontaneous), and the reversal agents used if hospital is reached in time. I have no special knowledge in this regard, and am willing to be corrected, but I currently believe reversal is similar for both anticoagulants.
You sound like you have similar concerns to mine, so please comment if you think my thinking is anywhere misplaced.
And do let me know the results of your upcoming discussion with your medical expert.
bob
PS. However, my Reply comes with the following "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"
Thanks, BobI think you are very much on the same lines as me.
It is all about balancing risks and I'm worried that my doctor will not appreciate this. I'm happy to risk being off anticoagulants for half a day once or twice a week so that I can feel less anxious on my bike rides but will my doctor want to actively facilitate this?
The alternative, that I'm currently employing, is to take half an Edoxaban the night before.
The half life of apixaban and edoxaban are about the same, circa 12 hours. If you miss 4 doses post steady state serum levels then the drug is almost out of your system. Like you I cycle, to my mind delaying ingestion of either DOAC until after a bike ride will have little benefit. Unfortunately you have a history of TIA. To me this would imply a much greater risk than a bleed if you fell off your bike. I think that there is a consensus of opinion amongst medics that on the whole a stroke is likely to have a worse outcome than an intracranial bleed from DOACs.Enjoy the cycling, spring weather is almost here.
I'm 60 and also bike a lot. (5000+ km/year) I just switched to Eliquis from Xarelto after numerous sources indicated that Eliquis is both safer and more effective. I also liked the idea of two a day instead of one. I take my morning dose at 8am and do most of my rides in the afternoon.
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