Condition: Atrial Fibrillation + unstable Angina; has bare metal stents; aged 94. Long-term NOAC Apixaban+Aspirin was recommended by hospital Consultant after serious angina attack. Before A+A, prescription was for Clopidogrel+Aspirin. GP stopped A+A and now prescibes only Clopidogrel.
How would this affect risk level for AF / Angina / Stroke? Thanks for any advice!
Sounds like GP is trying to reduce risk in bleeding. Clopidogrel and aspirin also known as dual anti-platelet therapy has been shown to be effective after a few months after stent placement with switch to clopidogrel only for coronary artery disease. 5 different trials have shown being on clopidogrel compared to DAPT is similarly efficacious at preventing disease while decreasing bleeds by 40%.
With regard to apixaban. If you have atrial fibrillation still then they should not stop apixaban. Only reason to stop a blood thinner like that is in the event of a major bleed or concerns about caring for self. Otherwise, I don’t think it’s advisable to just stop it because they want to. They should discuss with the original prescribing provider.
Thank you. Stent surgeon recommended Clopidogrel (short-term) +Aspirin (indefinitely); but GPs for years continued prescribing both until recently. Do you know whether Apixaban+Clopidogrel is ever appropriate for elderly patient with bare metal stents who has AF and unstable angina?
Yes. It is appropriate. Apixaban for stroke in setting of AF. This is typically lifelong unless you are no longer having AF, which rarely happens.
If you have unstable angina with prior stenting and CAD then most transition to clopidogrel which confers the lowest risk of bleeding when combined with a DOAC (apixaban). Clopidogrel appropriateness should be revisited every year based on your clinical course.
If your stroke wasn’t from AF, I could see using clopidogrel mono therapy. Sometimes strokes come from bad atherosclerosis. But if you’re still having active AF, the last thing I would stop is apixaban. Seems backwards to me. I’d ask what their reasoning is…. really. You might be surprised at the answer. Some would see your age and stop apixaban immediately when it really should be adjusted to your functionality, not the number.
Thanks for your replies: I emailed GP with lots of Qs - in reply GP said surgery had known patient had been admitted to hospital, but did not receive discharge report (though care home did). Care home didn't pick up on discrepancy between hospital recommendations and prescription list (i.e. not changed); so GP never did prescribe Apixaban+Aspirin as recommended. More communication with GP led to Apixaban being prescribed, but Aspirin not (higher risk of bleeds), with Clopidogrel stopped (as advised by hospital). Shocking; almost 18 months since hospital admission before this was discovered and remedied. To anyone reading this: NEVER be afraid to ask your GP questions about medication!👍
How horrible, but glad you found a solution. Apixaban monotherapy sounds 👌. So happy you reached out to your GP!
