ischaemic heart disease with E/T

[Phil1955]

hi all I’m 68 male had splenectomy in 2014 started hydroxycarbamide in 2015 high risk E/T and PV I’m on lots medication and 1500 mg daily Hydroxycarbamide

I recently had a heart angiogram which shown high calcification in my main LAD heart artery moderate to severe

They put me on Apixiban and atorvastatin 80 mg and asprin but the cardiologist stopped my aspirin

On Wednesday I spoke with my Haematolygist who wants me back on the aspirin is anyone else on both aspirin and Apixiban please

[Rem31]

I take aspirin and would be alarmed if it was suggested I should also take Apixaban without very explicit reason and discussion. I would think it potentially harmful due to increased risk of bleeding. It sounds like your cardiologist and haematologist need to communicate directly and not via you the patient.

I have a chronic heart condition and, speaking from personal experience, some cardiologists I have come across in the past have been apt to be a mix of arrogant/dismissive/ignorant around non cardiac conditions and their treating clinicians. I often felt I was viewed solely as a cardiology patient which was frustrating. Not so with the Mpn team that treats me, thankfully.

[Phil1955 in reply to Rem31]

Hi thanks for your reply my Haematolygist said Apixiban prevents clots and strokes by 70% and asprin heart attacks he’s emailed the cardiologist to discuss having me back on both he did an assessment on bleeding risk and said I’m fine !

[hunter5582]

While apixaban and aspirin are both used to prevent thrombosis, they are two different classes of medication. Apixaban is an anticoagulant medication. Aspirin is an antiplatelet medication. They are working on two different parts of the cascade needed to form a clot.

The two medications are sometimes used together when indicated by the patient profile; however they need to be carefully monitored and potential dose modified when used together. Here is the warning about the interaction between the two,

Monitor/Modify Tx apixaban + aspirin monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, incl. life-threatening (additive effects) epocrates.com/online/intera...

The two doctors need to collaborate on your case. It is unlikely that the cardiologist is fully aware of the treatment needs of someone with a MPN. The hematologist can do the best job of explaining the needs to be on both apixaban and aspirin as well as approase the risk and need for dose modification.

Please do let us know what you learn and how you get on.

[Phil1955 in reply to hunter5582]

Thanks so much for your reply I will definitely get back to you when I hear off Professor Sommervaille he is one of the top MPN specialists in the U.K.

[Foodies]

I was taking aspirin and Apixaban together for about 2 years but was experiencing a lot of bleeding so now only take aspirin once a week and 1/2 an aspirin when I experience a severe headache. I’m lucky that my haematologist and cardiologist always communicate if there is a change required. Best of luck.

[Phil1955 in reply to Foodies]

Thanks for your reply that’s good to know I’m just waiting on my Haematolygist emailing my cardiologist he wants me on both he did a risk assessment on his laptop regarding bleeding

I was ok for a month on both in 2017 I attended A&E with passing blood for 24 hours had all tests but showed nothing

[Mirror368]

I take Eliquis for AFib and my cardiologist advises me to not take aspirin. I am only to use Tylenol. Eileen

[Phil1955 in reply to Mirror368]

Hi thanks Tylenol is just a pain killer I think not an anti platelet I’ll let you know what the Haematolygist says after contact with the cardiologist

[Minify]

I take both Apixaban and low dose Aspirin, also on Pegasys. I was already on the aspirin for a previous stroke in 2019 when I had a submassive PE in October 2023. I’m now on lifelong Apixaban. My hematology team and neurology consulted on whether I should stay on aspirin, whilst on Apixaban. They all agreed yes. I was told the low dose aspirin has a different mechanism of action and is needed for stroke prevention.

I’ve fully recovered from both events, have no lasting limitations, exercise regularly and live a healthy lifestyle.

I have not seen any extra bruising on both meds, but I am super careful to avoid any type of injury.

So, yes, in some situations, taking low dose aspirin along with Apixaban is indicated.

[Phil1955 in reply to Minify]

Hi that’s interesting I’ve had a TIA was put on the Apixiban the asprin was initially prescribed by the cardiologist I was on both and long term atorvastatin 80 mg but the cardiologist removed the aspirin without emailing my Haematolygist

[Minify]

Phil, Your high grade LAD lesion puts you at high risk -and likely plays into the decision re medication. I have zero cardiovascular risk factors, great BP and cardiac rhythm, perfect cholesterol, Normal Stress ECHO and stress EKG. But the weird stoke I had in 2019, totally unexpected with very unusual presentation, is why I am on the Stroke Prevention protocol which includes low dose aspirin and statin. The severity of the PE is why I’m on lifelong Apixaban. I am extremely grateful for good health care that has facilitated full recovery from both of those events.

It’s important to remind ourselves that even though we share an MPN diagnosis, our treatments will vary because of other co-morbidities. One shoe does not fit all!

[Phil1955 in reply to Minify]

Hi that’s so true on one shoe doesn’t fit all unfortunately I’m on two blood pressure medications Irbesarten and amlodipine the TIA I had wasn’t really that bad I’d had previous blood clots in my right calf which was the main reason for Apixiban

I hope your ok now and back living your life I’m worried at present with chest pains intermittently but hopefully the team will sort things