I have recent diagnosis of ET and mylofibrosis. Had gangrene in 5 th toe at Christmas...long story. I have been on Apixaban since 2016 for very infrequent Atrial Fib( only had 2 episodes in 4 years) and wonder now whether ET set this off. I am now also on clopidergrel daily and Hydroxurea 1 gm/ alternating with 500mg. My platelets are coming down but I wonder about long term management! Anyone one else on this cocktail?
Worried about all the anticoagulants I am taking... - MPN Voice
Worried about all the anticoagulants I am taking ...
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It is understandable you would be concerned about the combination of apixaban + clopidogrel. Here is the interactions check for ePocrates.
Monitor/Modify Tx
apixaban + clopidogrel
monitor bleeding s/sx: combo may incr. risk of bleeding, incl. life-threatening (additive effects)
Not sure how long you have been on HU nor what the cause of the gangrene was. Do be aware that gangrene is a known serious adverse effect associated with HU.
online.epocrates.com/drugs/...
Recommendation from the manufacturer is to discontinue the HU in the event of vasculitic adverse effects like gangrene.
packageinserts.bms.com/pi/p...
I hope others can weigh in with their own experiences with these meds. Your concerns are quite reasonable and should be reviewed with your care team.
Thanks Hunter, the gangrenous toe was the result of the thrombosis that led to my diagnosis of ET/ Mylofibrosis. I have only been on HU for nearly 3 months. I see my heamatologist in 10 days and I had a review with a cardiologist a month ago. He didn’t suggest reducing the Apixaban but expressed concern regarding the additional clopidergrel, which was commenced just prior to HU. ( 3 months ago). I think I will ask the heamatologist who should be taking responsibility for this combination of medication? I have read where the dose of Apixaban can be reduced to 2.5 bd. Instead of 5 mg. BD. Thanks for your support and hoping I don’t suffer any adverse effects. Hope you are ok too, cheers and thanks, Chris.
That is a tough way to find out about the MPN. Hope you do not encounter any further issues with thrombosis or gangrene. I would definitely review the blood thinners with the hematologist. Would also be sure to include a MPN Specialist on your care team. Your case is complex enough that you really want very specific expertise beyond what a regular hematologist can offer. FYI - I also had an arrhythmia - paroxysmal atrial tachycardia. Ended up having surgery for it (which was successful).
All the best.
Hope you get some advice- I can’t help I’m afraid xx