Warfarin to apixaban for AF

[Maurice23]

Following my Cardiologist's recommendation, I have today switched from warfarin to apixaban. Is there anything I should be aware of (apart from being vigilant about regular dosing and bleeding)? Have studies shown apixaban to have advantages over warfarin for atrial fibrillation?

[Hidden]

I have no experience with warfarin, but I gather from those who have that you have to have regular blood tests, and have to avoid certain foods. This is not the case with the more modern anti-coagulants. My father's on apixiban after a stroke, and I'm on rivaroxaban after PE, and honestly, neither of us knows we're on it. I have to be careful to take mine with food, but I only have to take one tablet a day; he has to take two, but it needn't be with food..... I am sure you'll like it once you're used to it (it may take a week or so to adjust).

[Maurice23 in reply to Hidden]

Thanks, that's very helpful.

[virgin543 in reply to Maurice23]

This of course does not mean all warfarin users can switch. I wanted badly to switch to Apixaban has heard such good reports of it being less tiresome to use than warfarin but was told by my doctor that as i have a Metal Jude Valve replacement i cannot use. Warfarin is affected by some pretty unavoidable things if you want to live your life..alcohol certain foods and vegetables, homeopathic and herbal medicine remedies and stress. It is difficult to keep level but after a few years i learnt how to tweek. However if you cannot appear to tweek and get your level sorted yourself, you truly need to speak to you doctor. It is dangerous to continue with an unhealthy INR.

[Maurice23 in reply to virgin543]

Interesting, thanks.

[Josiehg]

I have been on Apixaban since January for a dvt and pe and have had no problems. I don’t even know I’m on it. The only time I remember is when I cut myself or have a routine blood test.

[Maurice23 in reply to Josiehg]

Thanks.

[Hidden]

The ARISTOTLE trial is the one that is generally held up to be the main comparative study between apixaban and warfarin in AF. Its conclusion reads "In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality." nejm.org/doi/full/10.1056/N...

The important thing about all the new drugs, including dabigatran, rivaroxaban and edoxaban, as well as apixaban, is that adherence is absolutely critical - they MUST be taken every day to achieve the necessary effect, without any missed doses at all.

[Maurice23 in reply to Hidden]

Interesting and helpful, thanks.

[Maurice23 in reply to Hidden]

Interesting that the ARISTOTLE trial reported in 2011, so apixaban is hardly a new drug any more, and should by now have amassed considerable evidence of efficacy and safety.

[Keithff in reply to Maurice23]

Yes it is no longer a new drug, but it is a lot better than warferen.

22 years ago I used warferen but it almost killed me. As I over react to it. I became classified as haemophiliac within days of starting it.

Twenty years later I had more DVTs. Only this time they went through my heart to my lungs.im now on Apaxaban for life. No problems. I have a blood test every six months. Mainly because I keep getting serious chest infections. I also have Arithmia and sleep apnea. Things I can do nothing about.

I have discovered that if you need a tooth extraction. You stop the Apaxaban 24 hours before and start them again 24 hours afterwards

[moo196]

My concern about the newer anticoagulants revolve around there being no antidote in the event of any accident or need for dental work or suchlike.

At least with warfarin one can get vitamin K to assist.

I was on warfarin for 2 years following an unprovoked cvst and we spoke about diet restrictions and was told dose the diet, don't diet the dose. So I could continue on my normal vegetarian diet that includes at least 3 of the "banned" items daily. Broccoli, avocado, chickpeas, spinach etc.

I'd be asking questions about the newer anticoagulants

[Maurice23 in reply to moo196]

Good advice, thanks.

[Josiehg in reply to Maurice23]

With planned operations and dental work you just stop taking it for a day or two and then it’s not a problem

[Maurice23 in reply to Josiehg]

Coincidentally that's just what my dentist told me yesterday.

[moo196 in reply to Maurice23]

It's just if it's unplanned or accidentally fell off your bike/cut your finger whilst cooking etc.

I much preferred to take the tried and tested warfarin

[Maurice23 in reply to moo196]

Interesting, thanks.

[subo2 in reply to moo196]

The newer tablets are much safer.

[moo196 in reply to subo2]

Safer in what way pls? Is there now an antidote if required??

[Hidden]

Yes, I've been told that an occasional missed dose of rivaroxaban isn't a problem, but if you miss more than one you have to have an injection; I believe if you need surgery that's exactly what happens - you stop taking it a day or so in advance and they give you injections until you're able to take it again.

[Maurice23 in reply to Hidden]

Very interesting, thanks.

[subo2 in reply to Hidden]

Sorry, but that is incorrect. The injections work in the same way and you do NOT need to take an injection if you miss one. Just take it as soon as you remember

[Hidden in reply to subo2]

I know not if you miss one - it's if you miss more than one, if you have a bad attach of gastric flu and can't eat for several days, for instance.

[Hullensian]

I have been taking Apixaban for 14 months. Don't seem to have any side affects, apart from bleeding slightly more when I cut myself. I just do what my GP advised - put pressure on the cut with a clean finger until it stops. Sometimes takes a while, depending on which part of my body the cut is. My concern is the same as other contributors - that there is no antidote if one has an internal bleed. Hopefully, some research will change this in the future. Whilst my GP would not tell me whether or not he would take it as opposed to Warfarin, my Pharmacist advised he would definitely want to take it if he had AF. I try to reduce my risk of falls, (very careful about step ladders), tripping and always now wear a cycle helmet. Always carry a completed "form" from the tablet pack with me. Am a bit OTT, inasmuch as I have one in every handbag/shopping bag/purse and I wear either an ID velcro band that has a slip inside detailing all my medication or a bracelet with a engraved stainless steel ID heart. As I said, I am OTT. Don't worry, you will soon get used to taking it.

[Maurice23 in reply to Hullensian]

That's very interesting, thanks.

[motorbike in reply to Maurice23]

Hi Maurice23. I’m on Clexafin 100mg , but next week I start apixaban next week . I dread my osteoporosis. They have stopped My Naproxen, Volteral, HRT, since April 1st when I got DVT in leg , and PE Mass lungs. My bones and back are really hurting . I have Paracetamol, which hasn’t really helped st all. Also Dihycodeone , which do help. However who wants to take them regularly. I’m just feeling sorry for myself . Never been ill like this , so has rocked the boat, as they say .

[Emarho in reply to Hullensian]

I have not noticed a difference in the quantity of bleeding on Apixaban.

[blmbmj]

I have been on Eliquis (Apixiban) for nearly six months. It has wreaked havoc on my osteoarthritis and caused severe shoulder and neck pain. It has sapped my energy and made me feel old. I had a massive DVT, from calf to groin. Hopefully it has lysed and I can go off this Eliquis.

I am not alone. Read some comments on this page. peoplespharmacy.com/2013/08...

[Maurice23 in reply to blmbmj]

Sorry to hear that, I will be aware of such side effects if I experience them. Thanks

[Maurice23 in reply to blmbmj]

Have been on apixaban now for a month and, curiously enough I too am experiencing severe neck pain, especially when I'm in bed, also tiredness. I hope these will subside in time

[AndySD]

I experienced two gout incidents. Both were easily sorted but I did see some forum conversations where other Apixaban takers also had gout. It is not formally linked and is a minor worry in the scheme of things. Other than that, 12 months on Apixaban so far and no problems following a diagnosis of multiple unprovoked PE.

[wilsond]

I have beeen on apixaban since november 2017,after a TIA through having Atrial fibrillation and flutter ,with co morbidities of weight,female and high blood pressure,and not anticoagulated.

Can honestly say I have had no side effects. No reversal agent as yet ,but as it wears off quickly,bleeding events or accidents can be controlled reasonably fast,and fhere are several methods used by emergency teams.

Watch out for bacterial infections though,apparently all anticoagulants can make us more vulnerable to attacks,I cut my finger ..minor..in the garden in March,at 3pm.By 2 a.m I was in Acute A and e with Pre Sepsis,intravenous antibiotics and 3 weeks worth of strong antibiotics after!!

All the best