Apixaban

[Greenhilldrive]

I wonder if there is anyone here who is over 80, weighs less than 55kg and is on Apixaban?

I was on warfarin but due to my INR being very unstable and also my forgetting to take it sometimes, my cardiologist switched me to Apixaban which I found a great improvement in that there were no more diet restrictions and I just took it with my morning and night medication.

However, I am on 5mg twice a day and I do have friends (who see different doctors) of my age group and of similar body weight who are on 2.5mg twice daily. I asked my doctor if I could go on the lower dose, but she said that since my kidney function was normal, I would be more protected on the 5mg dose. I noticed quite a bit of hair loss 6 months on and was hoping that a half dose would suffice and it would also mean some savings, obviously.

I am almost tempted to half the dose without her knowing, but do not want to put myself at risk of a stroke. I wonder if I should consult a different cardiologist just for a second opinion.

What do you kind folks think? Thank you.

[moo196]

I'd stick with the medical advice.Sadly nothing comes with no risk. Maybe chat with your medical team and write out a risk benefit analysis?

[Greenhilldrive in reply to moo196]

Thank you for your response. Yes, I will take your advice.

[ozziebob]

I am a 78 year old male. However, I have read the NICE eligibility guidelines for half dose apixaban, and you certainly meet the criteria ...

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

So I am somewhat surprised by the response of your doctor(?), and your suggestion to seek a second opinion seems very appropriate.

Hopefully some of the many (female) Forum members who have previously mentioned successfully switching to half dose apixaban will be able to offer their experience and suggestions about taking your concerns further.

I mentioned yesterday in a reply that research seems to indicate that stroke risks are higher on low dose compared to standard dose Apixaban. However, that study had a cohort described as "older adults", with a large percentage of patients not meeting the NICE criteria for low dose apixaban. So how relevant is this limited research for you?

I would also consider asking your doctor(?) for the evidential basis for her understanding. At least then you will be better informed.

Good luck.

[ozziebob]

It's me again. I've only just realised this is an Anticoagulation Support Post.

But I suggest you also Post it on Atrial Fibrillation Support as the membership is much greater in that Community and the feedback about this matter from Members I referred to was in that Atrial Fibrillation Support Forum.

[Greenhilldrive in reply to ozziebob]

Thank you again for taking your time to advise. You are right.

[ozziebob in reply to Greenhilldrive]

I notice you haven't yet rePosted on the Atrial Fibrillation Support Forum as I suggested, but if you need the extra feedback available, don't delay. Your query is very important.

Alternatively you could do a search of past Posts in the Atrial Fibrillation Support Forum ... something like "half (or low) dose apixaban".

[Jumper99]

hi. I can’t see anything that says why you need to take anticoagulants. We also do not know your medical history. Although you do mention not wanting a stroke rather than talking about a heart attack. So it is impossible for us to judge what medication level you should be on. For example, I have APS and have to be on warfarin, you may have something that means you are better on the higher dose. I would suggest getting together the information you have and then talking to the doctor again. They really are the people to decide what’s best for you. Changing your dose without permission does not sound like a good idea at all.

[Greenhilldrive in reply to Jumper99]

Oh, so sorry I omitted mentioning that a have Afib, diagnosed since 2020 and was on warfarin until April last year before switching to Apixaban.

I’m also on Sotalol 80mg x 2 a day, atenolol 25mg daily, and Artovastatin 10mg daily. With Apixaban on top of all that I feel rather overwhelmed.

Thank you so much for your response.

[Warfarin2014]

Strongly recommend a 2nd opinion. Self-medicating is dangerous.

[Greenhilldrive in reply to Warfarin2014]

Thank you, will take your advice