Worried about all the anticoagulants I am taking ...

[Cabert]

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?

[hunter5582]

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.

[Cabert in reply to hunter5582]

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.

[hunter5582 in reply to Cabert]

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.

[Wyebird]

Hope you get some advice- I can’t help I’m afraid xx