Apixaban

[cruisa]

I had a text from my GP to say that they are reducing my dose of Apixaban tablets from 5mg to 2.5mg It said this came about after "part of an audit looking at anticoagulants".

Has anyone else had this news?

[RagdollRagdoll]

I'm on 5mg and they are keen to reduce mine to 2.5mg once my syptoms have settled down.DVT PE and Afif

[cruisa in reply to RagdollRagdoll]

I've been taking Apixaban for over 7 years now though, & haven't had my blood tested for a year. I find it strange that they are halving the dose without even seeing me.

I was wondering if it's a National policy that they are implementing.

[RagdollRagdoll in reply to cruisa]

Consultants after 3 months wanted to half it but i refused,I had DVT,PE and AFIB maybe now I would consider it with tests

[Bloodredroses in reply to cruisa]

Weird huh ? After a year on Rivaroxaban way back , my Heamo said NHS new guidance to stop it . I said take what ? She said Warfarin !!! No alternate . I said NO WAY .

drying covid she said take it EVERY day and your statin .

After I asked to reduce to 10 mg as negative tests . Now need an alternative as irritates my bladder .

[moo196]

perhaps there is new evidence to suggest the risk/benefit analysis has changed?

[Bloodredroses in reply to moo196]

kinda get that impression huh?

[SpeedyH]

I would imagine that the 'audit' referred to is the internal one that GP surgeries do in order to ensure that people with long-term conditions are still getting the most beneficial medication.

With apixaban, the dosage depends on what condition is being treated, for example the usual dose for preventing recurrence of PE/DVT is 2.5 mg twice a day. The audit will have taken into account your other factors like kidney efficiency, age etc and balanced your personal risk of getting a severe bleed against risk of clotting. Your GP probably used the NICE guidance along with your specific health profile to make this decision but should have discussed this with you rather than just send out a text.

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

[Bloodredroses in reply to SpeedyH]

No time for that mdear

[Buttercups22]

Hi there. If you are slender this might possibly affect the dose. Perhaps the dose might have been reduced if your doctor noticed that your weight is on the lower side. I had my Edoxaban dose reduced for this reason. I’m not sure whether the same applies to Apixaban, but possibly it does.

[cruisa in reply to Buttercups22]

My weight hasn't changed for years, so it can't be that.My GP surgery is a bit of a mess TBH.

It's a nightmare trying to see a GP, & when you do they're mainly students.

I think it's actually under special measures or something at the moment.

[ozziebob]

There are 3 criteria (you need 2 to comply) for reduced dose of Apixaban, first is => 80 years old, second is low weight (<=60kg?), and third is low kidney function. You will be able to do the calculation, or seek out the NICE half-dose guidelines online.

Then again, because of previous brain bleeds, I am interested in understanding the effectiveness of half-dose Apixaban, and I found this article ...

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

Definitely worth reading, and very relevant results (given authors have no conflicts on interest). Consequently my current choice would be for full dose Apixaban if I could tolerate it.

But your situation will be medically unique, and very annoying that you weren't given the medical reason for this decision.

Best ask your GP for the rationale for their switch.

[Tofino5 in reply to ozziebob]

Thanks for posting. Interesting read, although I find it frustrating that rivaroxaban and apixaban are treated as identical meds in the study, which they aren’t. Also wish the NICE guidelines were available to read outside of the UK.

[ozziebob in reply to Tofino5]

Tofi,

Can you help me with understanding your issue re "treated as identical meds in the study"? I sense from your Bio you have useful information on anticoagulation that I would find helpful in regards to my current intracranial bleed fears following my unexplained chronic bilateral subdural haematomas on 2017.

Am I missing something by focussing on the conclusions where the two drugs did return different results? I must admit I didn't read the whole article.

And am I correct in presuming you are currently anticoagulated with daily doses of one of the anticoagulants in this study? Full dose?

Bob

PS. Not sure why you can't read NICE guidelines (it's just a world wide web address), if that's generally true, or just your situation, but if you let me know what you want to read, I'll copy&paste info for you and send in a PM.

[Tofino5 in reply to ozziebob]

Hi Ozziebob, I hadn't heard the term "full dose" until these posts. For over 7 years I was on 5 mg twice daily apixiban, then increased to 7.5 mg twice daily rather recently. I have APS and was on warfarin for many years but was very unstable on that, plus had bad side effects that were never tied to the warfarin.

My APS specialist will only use apixiban and while they are the same action, they're dosed differently. Studies usually treat them as the same, but their risks are different. One has a lower stoke, embolism and bleeding risk than the other. There are many studies, and honestly they are all over my head.

I recently had surgery to place coils and a stent in my brain for an aneurysm. That is when my apixiban was increased and I went on a statin. I have APS, sjogren's LA, hashimoto's etc. I've had DVT, PEs, and a mini stroke, which the docs are divided about whether it was a stroke or not.

Re NICE guidelines, when I follow the links I get this: "The NICE Clinical Knowledge Summaries (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories.". I am in the US.

Did I answer your question? If not, please ask again.

[Bloodredroses in reply to Tofino5]

You have been through the APS wars . I feel so unwell some days then normal next day . Total cold intolerance , toasty room but sweating bullets cold skin on chest warm feet . Weirdo I am . Normal bloods . Feel normal next day . Nights are weird . APS is weird . I pray for you and hope it all goes well. 💕 pray 🙏🏻

[Bloodredroses in reply to ozziebob]

oz can you still do a PM on here? I cannot get that option on the more down arrow , just reply .

[ozziebob in reply to Bloodredroses]

PM is the Chat option at the bottom of my phone screen. Not on the Reply drop down menu.

[Bloodredroses in reply to ozziebob]

OK . No Private Chat option on view . Thank you

[ozziebob in reply to Bloodredroses]

Across the bottom of the Post & Reply screen, the options read ...

My Hub, Chat, Post, Alerts, Menu

... that's on my android phone, perhaps it's different with a larger device, but it must be there somewhere.

[Bloodredroses in reply to ozziebob]

Thank you . No it’s an iPhone 12 . No other device . Thank you

[Suebo2 Moderator in reply to Tofino5]

Nice guidance is available on the NICE website. It pertains to the uk but can be read anywhere?

[Tofino5 in reply to Suebo2]

Re NICE guidelines, when I follow the links I get this: "The NICE Clinical Knowledge Summaries (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories.". I am in the US.

[Bloodredroses in reply to ozziebob]

Oz how did you know you had brain bleeds ? What Symptoms please 👋

[ozziebob in reply to Bloodredroses]

The first I knew was an intermittent paralysis of my left(?) hand, initially lasting about 5 mins each time. Maybe a couple of times over 3-4 days or so. Not every day. As it recovered each time, I tried to "carry on regardless" to see what developed. However, while only occurring intermittently over a week, it didn't go away. I cannot remember if it was the events getting longer or the interim period getting shorter that pushed me to visit my GP surgery where, via an emergency consultation (this was late 2016), I was given a letter to take to A&E. After priority tests for TIAs and neck arteries, plus other heart tests, all negative, I was sent for a CT scan and was finally diagnosed by a neurosurgeon. To say that conversation was "the hairiest" of my life is an understatement. His diagnosis was acute bilateral subdural haematomas of unknown cause. But I was lucky too, the bleeding had stopped and so a "conservative" treatment plan was put in place. Mind you, I never hope to have to repeat the 10 days of steroids I then ensured (horrible!), but I realise how lucky I have been, especially after viewing the large pools of blood across both sides of my brain. I was also lucky that I avoided a bleed deep inside my brain, as my bleeds were ruptures of the blood vessels connecting the inside to the outer protecting tissue (sorry I can't explain better, search subdural haematomas on Google).

But, because the event was unexplained, I have been left with a fear of a repeat event. This has led me to decide to refrain at the moment from the apixaban anticoagulation I have been recommended. It seems to be accepted that a repeat event, if I was anticoagulated, and living alone as I do, could well prove catastrophic and incapacitate me before I could call for help. "Rock and a hard place" comes to mind.

Any reason you are asking for these details?

[Naniajes]

I would definitely look into this further was the apixaban prescribed by the gp to start with or someone else

Mine was prescribed by the haematology department at the hospital. My gp decided I did not need anticoagulants as I havnt had a p.e. in a while. So I got intouch with the specialist I was under at the hospital and enquired if I was to stop the apixaban he said no and was extremely annoyed about this as it put me at great risk of further p.es and possible second stroke.

I have since restarted the apixaban 5mg twice a day.

I'm not sure of guidelines around dosage.

I would definitely recommend a second professional opinion as im sure is not one size fits all when it comes to medication

[Bloodredroses in reply to Naniajes]

YESSS you are singing to the choir . My G P and others I see at practice would never dare interfere in dosage or stopping in APS Haematologist patient . No siree !!! They don’t want to . I like it like that ! Your Specialist was probably boiling angry 😡 . What the heck random ?

Mine is a Good practice, they email specialists first . They do the 6 monthly blood tests ( kidney watch) ordered by Haematologist . To me it’s unthinkable yanking a Patient on blood thinners off line that with no consult with specialist 😤 😡 NO ! They don’t even do that so casually in the A and E , I was admitted for gall bladder duct infection for 6 days, all my meds blood thinners , statins blood pressure pills , etc were bought to bedside night morning whatever . Plus pharmacist bought a supply to take home with .

[SASlk]

I was prescribed 5mg by my haematologist following a second DVT post surgery. However I was then reduced to 2.5 as a long term maintenance dose. I was told this dose has advantages without the disadvantages. Hope that helps.

[Suebo2 Moderator]

thank you for posting and had raised some interesting comments.

First of all - AF and VTE (DVT and PE) are not the same condition and consequently the dose for each can be different.

For AF the dose can be reduced depending on individual circumstances. - as mentioned above in the comments

For treating VTE the dose is not reduced initially. However, the licence for treating VTE with apixaban is 10mg twice a day for a week, then 5mg twice a day. After 6 months the licence is for 2.5mg. This is where there should be a discussion with a haematologist who will look at individual risks - for example what caused the clot in the first place - might need to stay on the larger dose to prevent recurrence, but continuing on 5mg is ‘off licence’ but it is safe.

As regards picking this up at audit, that is good, and you just need a wee bit more information from your GP.

Good luck.

[Hullensian]

I have been "on" 5 x twice a day for years, but, my bloods are tested each year. I am 76 years and weight 60kg. I think you ought to contact you Surgery, even visiting, and insist you have a GP appointment.

[cruisa]

I contacted my GP to find out the rational as to their decision, (as suggested in a reply to my OP), & it seems that, after an audit within my GP Surgery, they discovered that my medication should have been reduced a long time ago. As I understand it, the 2 x 5mg a day were to treat my condition, & this should have been reduced to 2 x 2 5mg a day to prevent further problems.

All a bit scary really 😨

[Tri-Ing72]

Hi. No I haven’t had this. I too am on 5mg Apixaban following x2 DVT. Maintenance is 2.5 mg however I was advised by the consultant to stay on 5mg due to my lifestyle. I travel long haul a lot, and complete in half marathons, marathons and a lot of cycling. Hence the risk of dehydration is greater. I think if my gp surgery asked me to reduce I’d ask them to liaise with the consultant first….or I’d be emailing the consultant to ask their advice.

[cruisa in reply to Tri-Ing72]

In the end, I found out that I should have been moved down to the lower (preventative) dose years ago, but somehow they missed doing this. The last time I seen the consultant was equally years ago, when they attempted to fit a couple of stents, but in the end, after I overheard the consultant arguing with the person who was going to fit the stents, they didn't.

One good thing that happened lately, is I turned 60, so at least I don't have to pay for prescriptions anymore 😊