Apixaban

[bikerider00]

I have had PAF for about 13 months. Had EP consult end of Feb. An area we didn't really end up discussing - we somehow managed to digress and didn't come back to - was DOACs. Just received the clinic letter. This says that my CHADS2VAsc score is 1: as a consequence of having had MI (which seems to have been the trigger for my PAF). The EP has recommended I come off the aspirin and clopidogrel and go onto apixaban (5mg/twice daily). In reality I have come off the clopidogrel since the call (>12 months since stent fitted).

I am disappointed: I was looking forward to not being on anti-coags as I thought my score was going to be below the threshold (Male by the way). I'm 60. Its a real shame I didn't get to discuss this with the EP and don't have another opportunity to do so.

In terms of propensity to bruise (previously read bleed), and also any other side effects, what is being on 5mg BD of apixaban likely to be like?

[mjames1]

The issue is to balance your stroke vs the risk of your stent clogging. The DOAC may help your stroke risk, but aspirin is going to help your stent issue more.

The options are aspirin or DOAC or both (Dual therapy). But given your risk score is only one, the DOAC is usually optional.

I understand that your EP wants you on a DOAC, but what does your interventional cardiologist who did your stent say?

If I was in your position with the chad's 1 with stents, I would take baby aspirin only. That's just what I would do, but you really need to come to your own decision after speaking to both of your doctors.

Jim

[bikerider00 in reply to mjames1]

Thanks. I thought at this stage (>12 months since stent fitted) that the aspirin was 'just' there for clot prevention generally, rather than specifically for the fitted stent (that is what I thought the clopidogrel was for, and hence why only for 12 months to allow it to fully 'bed in'). I am aware it is not considered sufficient/appropriate though for AF clots.

The problem I have is that what with this being the NHS, I don't think I'm going to have any discussion back with the original referring cardiologist. Not that I'm aware of. Grrr.

[mjames1 in reply to bikerider00]

Whole thing gets murky if you have both atrial fibrillation and stents. I am also in that position, but I have a higher risk score than you. All you can do is speak to the doctors you can and do some independent research. Not 100% sure but at least in the United States I think the recommendation may be to start a NOAC in 12 months and then either continue or stop the aspirin. But that's just overall, the fact that NOAC's are optional for you, at CHADs 1, I would think would make a difference

Jim

[wilsond in reply to bikerider00]

Even in NHS currently I find contacting your consultants secretary, by email preferably, gets results quite quickly, especially given you have such an important query.I can't comment on the stent side, but have been on Apixaban for years with no significant bleeds,despite my best efforts being clumsy! Small.cuts just take longer to stop. Xx

[Qualipop in reply to bikerider00]

6 years post HA, two stents, no AF but arrhythmia. . Clopi was stopped after 6 months but told aspirin is absolutely for life and not to miss even a day. I asked to stay on clopi instead of aspirin as it was killing my stomach but t old a categorical NO. No explanation given.

[RockingRoxy]

I am on Apixaban 5mgs twice daily and in terms of side effects I don’t have any at all. I don’t appear to bruise any more than I did and when having blood taken or a minor cut it’s made no difference. Fortunately haven’t tested it on more significant injuries. I feel’ safer’ taking it having had a PE followed by an episode of PAF.

[bikerider00 in reply to RockingRoxy]

Thanks. When on clopidogel I was bruising easily and bruises persisted for a long time. That has quickly returned to normal in the 3 weeks ove been off it, so was rather hoping I wasn't deemed sufficiently at risk to go onto another.

I hope my experience is going to be similar to yours.

[OBRA in reply to RockingRoxy]

This is exactly my response to being on the same dose as you. I’ve only had minor cuts, grazes and bloods taken several times, but haven’t noticed any difference.

[Morges]

if you take aspirin you should also take a PPI. So that's 2 meds to take. I prefer to take Apixaban - not had any side effects from it.

[BevCynfelyn]

I've had one serious nosebleed in the last 9 years. That's the only negative effect Apixaban has ever had

[TillyBoss]

I was pretty anxious about bleeding when I went on apixaban and would freak out even if I saw a spot of blood after blowing my nose. One day I tripped and fell on my knees and punctured the skin in several places. Total freak out. But in the end the bleeding stopped fairly normally and all was well.

[bikerider00 in reply to TillyBoss]

Thanks for that. TBH, although I wrote 'bleeding' in my post I really meant to say 'bruising'. Having been on Clopidogrel for 12 months I became relatively comfortable pretty quickly with the bleeding/delayed clotting aspect (I'm pretty active and sometimes a bit cack handed so it didn't take long for me to 'find out'....

[dixiedad]

I've been on 5 mg for two tears. I bruise and bleed very easily. I'm getting a Watchman implant soon.

Good luck,

dixiedad 83, U.S.

[DawnTX]

I have been on an anticoagulant almost from day one and you would have to pry it away from my fingers. For some reason in the very beginning, I did bruise I no longer do I stop bleeding in a timely manner if I do get cut and bruising is not usually that bad. I had a bad fall a couple of weeks ago. only bruise I got was on my upper arm where I ran into the door frame with it. Anticoagulant or not I’m pretty sure it would’ve looked the same and I gave myself a shiner along with all kinds of other injuries, but I’m still standing

please don’t give up an anticoagulant. If you have a stroke you can never go back. Ask the people on here that have had if they could’ve turned the clock back. You are young possibly you can always check into the although it is not for everyone. I will be on my anticoagulant for the rest of my life. I was told that’s OK however much time I have left. I want to be me as much as and having a stroke would change that. part of my injury two weeks ago was running half of my face a metal and wood wall. I thought I was going to look like of the opera. I did not and doing that hitting my head, etc.. I wonder if it could’ve saved me even from death.

wait they are working on things every day. It’s just a tiny pill. You know you have a long time ahead of you. I want you to happily.