Cardiologist suggests I can stop taking Eliquis. Any thoughts?

Posted by dsisko @dsisko, Nov 18, 2020

I have been on Eliquis for about 2 years now for afib. I had a successful ablation at Mayo in Rochester in August 2019 and have had no afib incidents that I’m aware of since that time. I track my pulse with my iwatch and regularly track my blood pressure. Both are fine. I’ve been of the understanding that I need to take Eliquis for the rest of my life, however, my cardiologist in Florida has suggested that I could stop taking the Eliquis. Has anyone had a similar situation or has stopped Eliquis because of a successful ablation?

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Profile picture for ga29 @ga29

My husband was told he can stop taking eliquis after a time of no AFib incidents. He had a successful ablation a few years ago, 2020 I believe, and wears his Apple Watch.

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My husband had ablation in 2020, no afib since, but his doc says stay on Eliquis.

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Profile picture for tsch @tsch

My husband had ablation in 2020, no afib since, but his doc says stay on Eliquis.

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The medical community uses the calculus found in the CHA2DS2-VASc score. You can google an on-line calculator and derive your own score if you wish. Just be sure to put valid and current information in the fields or you'll get garbage for a score. If your score is above 1.5, you would be wise to take it (assuming cost and your body's reaction to it aren't problems). A score of 2.0 and above means a mandatory prescription for a direct-acting oral anti-coagulant (DOAC) like apixaban. Mandatory for the physician/cardiologist, not mandatory that you should take it...just a really good idea.
Your cardiologist wants you on apixaban perhaps due to one or more other risks than the now-corrected AF. But there's more; for up to six months after being rid of AF via ablation, you can still suffer a stroke from a clot dislodged from the left atrial appendage (LAA). The medical community has reckoned that quite a few strokes can be attributed to clots in the LAA long after the last episode of AF. !!!
Bottom line: while an ablation might rid you of the AF, there may be other comorbidities or risks that make staying on a DOAC for several months later wise, or even remaining on one for life. If it is well-tolerated.

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Profile picture for rubywitch67 @rubywitch67

Hi Martin! In your reply to @dsisko, you stated "you preferred to stay on Coumadin because it has a common antidote whereas Eliquis does NOT." I have come to trust your experience and knowledge which is why your statement really took me by surprise!
There IS an antidote for both Xarelto and Eliquis called ANDEXXA and also one for Pradaxa called PRAXBIND. These antidotes are now as readily available as is Vitamin K, the antidote for Coumadin. When I had my ablation and the choice of anticoagulants was discussed, Coumadin was definitely at the bottom of my list. I did not want to have to go in every month for a coagulation test, a possible change in the dosage of my medication nor did I want to have to be extra careful of my diet......watching closely that I did not consume foods that contained high levels of Vitamin K. Being a vegetarian, this would have moved a great many fruits and vegetables to my "DO NOT EAT" list. Since you have been on Coumadin for a long time, you are aware of what needs to be avoided or eaten only in small and infrequent quantities, but if anyone is reading this who is unaware of the restrictions associated with Coumadin, I will list a few fruits and veggies that are high in Vitamin K. (I didn't look up any meats, but I believe most cuts of meat are quite low in Vitamin K)
Dark leafy greens (especially kale, Swiss chard and Endive) broccoli, squash, peppers, tomatoes, eggplant, carrots, onions, cauliflower, string beans, peas, soybeans, kidney beans, raspberries, strawberries, cantaloupe, plums, grapes, papaya and rhubarb. This is NOT the complete list of high Vitamin K foods and there are also a number of common spices, like sage and oregano, which are high in K.
While there are pros and cons for ALL anticoagulants, I chose one that would have the least impact on my daily life, not require monthly testing AND has an antidote. (It also had no side effects for me) My coagulation rate is checked at my regular 6 month cardio check ups and during the two years I've been on Xarelto, the results have been excellent.
I believe all the anticoagulant choices are good and safe and it comes down to personal preference. And you can always change if your choice is not working well for you.

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Hi, Thanks for sharing about ANDEXXA. I will remember that. I am on Eliquis. I have often wondered about the about the antedote.

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Profile picture for gloaming @gloaming

The medical community uses the calculus found in the CHA2DS2-VASc score. You can google an on-line calculator and derive your own score if you wish. Just be sure to put valid and current information in the fields or you'll get garbage for a score. If your score is above 1.5, you would be wise to take it (assuming cost and your body's reaction to it aren't problems). A score of 2.0 and above means a mandatory prescription for a direct-acting oral anti-coagulant (DOAC) like apixaban. Mandatory for the physician/cardiologist, not mandatory that you should take it...just a really good idea.
Your cardiologist wants you on apixaban perhaps due to one or more other risks than the now-corrected AF. But there's more; for up to six months after being rid of AF via ablation, you can still suffer a stroke from a clot dislodged from the left atrial appendage (LAA). The medical community has reckoned that quite a few strokes can be attributed to clots in the LAA long after the last episode of AF. !!!
Bottom line: while an ablation might rid you of the AF, there may be other comorbidities or risks that make staying on a DOAC for several months later wise, or even remaining on one for life. If it is well-tolerated.

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Hi and thanks for your suggestions. As it turns out my husband's CHA2DS2-VASc is 2 (I think from memory) due to age alone. He is 82. He has no other heart-related, weight, apnea or BP issues. So the conservative thing for him is to take Eliquis. He has no side effects from it and we can afford it, so its really a moot issue in my opinion. He is aware of the blood thinning risk, but it is relatively small compared to a stroke, in my opinion. He has had conversations with his cardiologist, and doc feels safest route is to take the med. I agree. He needs no other heart med.

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Profile picture for kancha @kancha

There is generic version of Eliquis. They do not sell it in USA but you can get it from Canadá online

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I did not think there was a generic form of Eliquis. I placed a order from Canada and won’t receive it for a week. My primary offered me this Canada supplier so I hope it is legitimate. They ask for information and sound very knowable even after Drs perscription supplied.

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Profile picture for tsch @tsch

Hi and thanks for your suggestions. As it turns out my husband's CHA2DS2-VASc is 2 (I think from memory) due to age alone. He is 82. He has no other heart-related, weight, apnea or BP issues. So the conservative thing for him is to take Eliquis. He has no side effects from it and we can afford it, so its really a moot issue in my opinion. He is aware of the blood thinning risk, but it is relatively small compared to a stroke, in my opinion. He has had conversations with his cardiologist, and doc feels safest route is to take the med. I agree. He needs no other heart med.

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I am in a similar situation as your husband regarding the continued use of Eliquis. I am 85 years old and my CHA2DS2-VASc is 2 with no other apparent issues. Other than the cost of Eliquis I have no problems taking it. While it is expensive, the downside of not taking it is more costly than the up-front cost. I was on metoprolol for a period of time prior to and then after my successful pulse field ablation. Now just the Eliquis.

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Every person is different and docs can have different opinions, but the safest route is to take it if one's health is good and it can be afforded. In CT some people who are low income can get it at a greatly reduced cost. Possibly in 2026, the cost will come down for everyone if what Biden started is continued. It was one of the drugs scheduled to be price-adjusted.

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Profile picture for tsch @tsch

Hi and thanks for your suggestions. As it turns out my husband's CHA2DS2-VASc is 2 (I think from memory) due to age alone. He is 82. He has no other heart-related, weight, apnea or BP issues. So the conservative thing for him is to take Eliquis. He has no side effects from it and we can afford it, so its really a moot issue in my opinion. He is aware of the blood thinning risk, but it is relatively small compared to a stroke, in my opinion. He has had conversations with his cardiologist, and doc feels safest route is to take the med. I agree. He needs no other heart med.

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If you look at the factors regarding the scoring of that method, practically any woman and most men over 65 with a history of hypertension and even a hint of any cardio history should be on a DOAC. go up a couple of years in age and almost everyone over 70 would be on them. Huge potential of candidates.

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I believe not all doctors love the CHA2DS2-VAS. The fact that age alone makes one a candidate for DOAC, makes it a poor measure in my mind.

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I have had 2 Ablation procedures, one on the lower chamber and the other on the upper chamber, which the Cardiologist told me that he felt they were both successful.

However, he informed me that I needed to continue to take Eliquis (5mg morning and 5mg evening) until further notice. Well, unfortunately, it looks like my AFIB returned which is very disappointing. Now I know why he wanted me to continue to take Eliquis because he was not really sure if my 2 Ablation procedures would hold up for the long run.

Therefore, I will continue with Eliquis for the rest of my life (I am 80 years old). It is what it is and there is not much I can do about it. I am not going through anymore procedures. I have had 3 cauterizations, 2 cardioversions, 2 Ablations and 1 Cardiac Cauterization.

I have been diagnosed with severe congestive heart failure, 2 upper chamber heart valves not closing properly and leaking blood, pooling of blood, AFIB, low heart rate (40 BPM), and severe pulmonary hypertension which affects my lungs and causes me to get tired, winded, exhausted and shortness of breath after walking a few steps. I am not asking anyone to have pity on me because it is what it is, and I have been dealt with these health issues so I will just cope with them the best I can.

You take care and stay safe.

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