Severe joint pain as side-effect of DOAC

[ArtCritic24]

Since Jan 2025 I have been prescribed Apixaban for AF but suffered very severe joint pain.....mainly feet, hands, hips.

After 3 months prescription was changed to Rivaroxaban but with identical side effects.

Now unable to walk without severe pain, to drive, to hold a pen, to cook, etc I am re4fusing to take the medication. My average sleep time fell from 8 hours before this happened to 5 hours.

I would like to know if this is a common side-effect....there is very little mentioned on this topic online.

[Threecats]

Hi ArtCritic

I have been on Apixaban since June last year but am in the process of switching to Warfarin due to increasing problems with joint pain, dizziness and sleep issues.

I had rheumatoid arthritis quite badly years ago and initially thought it was a return of that. However by a process of elimination I discovered it was Apixaban causing the issues. I have heard of others who have experienced similar problems on these drugs, so we are not alone! As I have persistent AFib and other risk factors, risk of stroke is increased, hence I’m now trying Warfarin. Perhaps it’s something you may also consider trying, if it fits in with your lifestyle?

All the best, TC

[bikebabe]

The side effect is not mentioned very much. I would research it before changing as DOACs are easier to use and have fewer interactions with other meds than warfarin. Maybe blood thinners per se change the micro environment within joints (lubrication/nutrition) and some joints more than others. I’ve used Woods glucosamine /chondroitin for years as it really staved off progression of knee arthritis (and the warfarin dose isadjusted accordinglyto compensate) but it seems to have no effect now but I dont dare stop in case it makes things even worse!!! Keeping active/mobile and motivating myself to get up when I really want to lie down is the only thing that seems to help. I’m hoping to get steroid shots in knees arms and shoulders to reduce inflammation. It becomes an issue of weighing up the risks of one treatment/risk/ problem against another. I have experienced the well known side effects of letrazole (hormone blockers) on my joints for 3.5 yrs (manageable) and have become noticeably worse since starting warfarin as well (can’t stand up when getting out of bed or from sitting). I thought and was told it was likely the hormone blockers but am not so sure now. So let’s keep sharing about what helps.

[SpeedyH]

Hi there. I have been on anticoagulants since 2017 after having clots in my lungs. I started with Rivaroxaban and the pains in my joints were so bad as a result that I changed to Apixaban. this made no difference and I now know that these two meds work in the same way. I then took Warfarin which made me feel worse - I think I was having an inflammatory response to the meds and I became ultra sensitive to the colourings in the Warfarin tablets. Like you, my symptoms were so bad on Warfarin too that I decided to stop taking any medication although it felt like Russian roulette and I knew I would likely die from more clots. It was that bad. I was gaslighted by all the doctors who said that muscle/joint pain is not a side-effect of the meds, that it was all psychological and then diagnosed me with Fibromyalgia which I knew was not correct.

Luckily I was referred to a Haematologist who, although he didn't believe my symptoms were caused by the meds ('Loads of people take Warfarin and I haven't heard of anyone else having a problem'), was willing to try me on Dabigatran which is also a NOAC but works in a different way to Apixaban/Rivaroxaban. I would say that it took 6/8 months for the pain to completely go away. The Haematologist also found that I was very low in vitamin b12, folic acid and D and I now get these on prescription. I have a very healthy diet and have never had abnormal blood tests prior to this so I believe that the meds caused that deficiency. It might be worth getting that checked out.

I don't know if you can take Dabigatran for AFib but if you can, it might be worth enquiring about it.

[ozziebob in reply to SpeedyH]

Helpful answer✔️. Yes, Dabigitran (aka Pradaxa) is one of the DOACs used for AF. However, in England you would need the kind of medical reasons you mentioned to get it prescribed, as it currently sits 4th out of 5 (ie. the 2nd most expensive) in the recommendation list of "best value" DOACs. And the current NHS instruction is to choose the cheapest option, if medically possible.

[SpeedyH in reply to ozziebob]

Perhaps a referral to a haematologist or cardiac consultant might be possible? I can see that getting it prescribed by a GP would be challenging now that they are budget driven. Good luck.

[ozziebob]

The first prescription for a DOAC is usually done by a Cardiologist, or hospital Haematologist, and the GP will authorise subsequent prescriptions. But there are always exceptions to supply a particular DOAC if clinically required, rather than an otherwise cost based decision.

[FraserB]

This is a side effect of some DOACs yet the majority never have any problems but there are few that do. It can increase the risk of slight bleeding into the already severe arthritic knee joint for example. This is because the joint may already has a very advanced case of osteoarthritis and because of this there can be some internal knee micro bleeding due to joint breakdown or even with mild trauma and that causes inflammation which then causes pain. All of this can be manageable with the guidance of a doctor.