Anti -coagulation dosage.

[pusillanimous]

Much is written on the subject of anti- coagulants and medicine dosage in general when administered to the elderly. I read that the dose of Eliquis should be lowered for the over 80s, but have not read (unless I've missed it) anything about lowering the dosage of Xarelto at that age. Does anyone have eaperience in this regard?

[Desanthony]

I asked my GP about this when I turned 80 and apparently it is only if you are under a certain weight. I am 11.5 stones and did not meet this criteria so am still on full dose of apixaban. I think it's somewhere around 9 stone (ish) - best to ask your GP or pharmacist.

[pusillanimous in reply to Desanthony]

Yes, I'm aware of the criteria for Apixaban, but I am on Rivaroxaban for which the normal dose is one 20mg tablet per day. I am 81 and 50kg and I just wondered if anyone had had their dosage of Rivaroxaban lowered because of age.I'm in South Africa and the DOACs are not all that widely used because of the cost, Warfarin is much more commonly prescribed, so I thought I would ask here first as the members are so well informed !

[Desanthony in reply to pusillanimous]

I have looked it up on the NHS website and it says nothing there. As I said it's best to ask your pharmacist, GP or consultant Cardiologist or EP

[pusillanimous in reply to Desanthony]

Thanks, In the next month I will be seeing both my GP and Cardiologist so I'll ask them what they think !

[Vonnegut in reply to Desanthony]

I’m 80 (and a half!) and just under 10 stone and have been fine without anticoagulants for some time now since Flecainide has put an end to episodes of AF for me.

[pusillanimous in reply to Vonnegut]

Interesting, so was this the decision of your Cardiologist and EP? because the general concensus is that there is no cure for AF and it is always around even if you do not experience obvious episodes, so you should still be on an anti-coagulant.

[Vonnegut in reply to pusillanimous]

As I’ve written here several times before, the EP who originally prescribed the Flecainide for me to take as a pip, told me that unless an episode of AF continued for a long time at a high heart rate, I was not at risk of stroke! Even when I only took the Flecainide as a pip, episodes never lasted more than a few hours and I only once required the additional low dose Bisoprolol, when my heart rate exceeded 140, twenty minutes after taking the Flecainide.

[pusillanimous in reply to Vonnegut]

Sorry, I have not read your postings on the subject before, but I still have to confess I find the decision 'unusual', but we must all be guided by the practitioner in whom we have confidence.

[Vonnegut in reply to pusillanimous]

None of the doctors in our surgery and none of the pharmacists have questioned my decision re the anticoagulants. I could always tell when I had an episode and could check with my Kardia but I hardly ever use that now though I do occasionally record my blood pressure on the app though that’s a problem as being American it thinks readings that would be fine here in the UK are high or verging on that!

[Buffafly in reply to Desanthony]

50kg

[108cat]

I'm on 30mg Edoxaban and underweight, not 80 yet but getting there. I asked my cardiologist if I could halve the dose he said it would be the worst of both worlds because I wouldn't have the protection, and I'd have the same bleed risk. I realise that's not the drug you're on but I had the same question.

Best to ask your cardiologist.

[pusillanimous in reply to 108cat]

Thanks, I will - there seems to be explicit instructions for Apixaban but not for the others !

[Desanthony in reply to pusillanimous]

Yes you would have expected them to have reviewed all the medications with the age and weight ratio and set out instructions for dosage which we could access. Seems not and we have to rely on asking. That's OK so long as you know to ask.

[Fastbeat]

My doze of xarelto was lowered to 15mg four years ago when I reached 80yrs,reason given by GP age

[pusillanimous in reply to Fastbeat]

Thank you, interesting!

[Silvasava]

My dose of Edoxaban has been halved a few months ago. I'm 78 and 10st. When I queried it I was told it was because of my height/weight ratio, I'm 5ft 10in.

[LaceyLady]

Good luck with that, I feel they’re reluctant to make a decision because of their perceived stroke risk

[ozziebob]

I think you will be interested in this 2022 Canadian research ...

Effectiveness and safety of low-dose versus standard-dose rivaroxaban and apixaban in patients with atrial fibrillation:

ncbi.nlm.nih.gov/pmc/articl...

[pusillanimous in reply to ozziebob]

Thank you Bob, a very interesting read. It does not however address the question as to what age and conditions should be used to lower the dose of Rivaroxaban, neither does it point out any contraindications for the higher dose. It does however state that the risk of heart attack is greater with the lower dose, so maybe it's better to stay with the standard dose !

[ozziebob in reply to pusillanimous]

I think the NICE guidelines indicate when lower doses are preferred ...

cks.nice.org.uk/topics/anti...

Keep searching for the info you need, don't give up.

Bob

[Desanthony in reply to ozziebob]

From quickly reading through that it seems that it is very individual - not just weight and height ration but taking into account co-morbidities and other things. At least we know there is a question to ask about dosage at age 80 the best thing to do is ask if your medical professional does not bring this up.

[Blearyeyed]

It's something you can only get an answer on from your GP or Cardiologist, that's true for all drugs not just cardiac ones , because it's individual to the patient.They like to check at different ages but that is because it's more likely that your weight , height and general health or activity changes too.

Some people are more likely to need various medication doses altered at certain age goal posts , but some may require an increase in dose rather than reduction depending on their BMI and symptoms.