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 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