Eliquis and AFIB

@peggyle - thanks for the information, I, too, order Apixaban from Canada and is less than $200/90 days, including tariff. In checking your source, it appears they import from Singapore via Africa. I prefer NA manufacturers. I handle the ordering myself; my cardio team doesn't want to be involved once they hand me the hard copy prescription. However I will look into your source the next time I need a new prescription to see if anything has changed. Thanks again.

@justlucky You might find a very limited number of phramacutical manufactures in North America for the same reason most items are now manufactured elsewhere, $$$.

@chickenfarmer They have been discussed, here and on afibbers.org forum. The drug isn't without its risks, and it's almost prohibitively expensive for many. Apart from that, there is no question that they are superior to both warfarin and acetyl-salicylic acid.

Are they necessary....for life once diagnosed with an arrhythmia? I don't feel they ought to be, but it depends....as always.....on other possible risks that might be in play. Do you sit for long periods at a gaming console or surfing on your tablet? DVT is always a possibility for those of we-the-aged who tend to sit more and longer. Do you have some AF residually, some flutter, or just PACs now and then? Each of those presents a risk of thromboembolic events, and for the reason that the LAA is not being 'flushed' out regularly, in normal sinus, of its pool of blood. The scientific community seems to have settled on the 12 hour rule, but the figure changes with the address of the EP/cardiologist being questioned. Twelve hours in AF means you take a DOAC for about a month......if...............IF.................it is self-limiting and doesn't repeat in that month. If you get another bout, now the signs are you are returning to paroxysmal AF, and not just a flu shot reaction, and you should be on a DOAC again indefinitely.

That is my understanding, as inexpert as I am, about what I have read of the literature...the most recent studies. Me, this guy, I'm calling BS. The reason is that, as soon as you have your initial run of, or return to, AF, and it lasts more than a couple of minutes, already the pooled blood in your LAA is NOT BEING REPLACED. Depending on the condition of one's heart, valves, ejection fraction, and how quickly the AF beats are taking place, you may start the congealing and clotting process in the LAA inside of seconds. One size does not fit all when it comes to heart health, heart structure, other heart defects and cardiomyopathy, and other 'remodeling' from previous bouts of AF or flutter, so we can't/shouldn't assume that the 4-12 hour rule is a good fit for every patient whose heart resumes its disordered rhythm(s).

My cardiologist told me I would be on both metoprolol and Eliquis for life. I stopped metoprolol six weeks after my second ablation for AF, but I still take the apixaban because I do sit a lot at a computer, I do fly on trans-Atlantic flights, and I'm about to turn 74 with a history of some mild heart disease and arrhythmia. It's insurance for me. But, if I ever continue to sleep while my heart goes into AF, and the chances for every patient with a successful ablation of returning to AF is rather high (sorry, it's true), then the apixaban will do its job.

@gloaming I guess I'm in the same boat as you in regards to sitting for a fairly long period of time probably too much, as I have a "side gig" as I call it, ( retirement being my main gig) as an editor for a medical ( not physicians, but nurses, lab and other health care providers) continuing education company, and other computer activities. I do get up and move around regularly though, exercise and try to maintain a healthy life style and diet.

I also regard the Eliquis as insurance, considering the risk factors I have for stroke, and not just from A-fib or those other pesky arrhythmias that pop up uninvited. I also have a fairly strong family history of stroke, and have seen more than one relative incapacitated and dependent on others following a stroke, or two, and I don't want to live that way.

My A-fib is paroxysmal, with a less than 1% burden, and my cardiologist knows exactly when and how long these episodes last as they show up on my pacemaker reports, but he's been insistent that I remain on the Eliquis, considering that I don't feel all the A-fib episodes, they can last anywhere from a minute or two to several hours, and I never know when they will occur. He also points out those other risk factors. At this point I can't argue with him. I'll be 79 in a couple months, and have a CHADs2Vasc score of 4, with a couple other comorbidities ( that are well managed at this point- thankfully NOT diabetic) so I have to regard the Eliquis as a small price to pay to mitigate my risk for stroke.

I'm also very fortunate that having a private ( not Medicare) drug care plan I can use the manufacturer's coupon to pay for the Eliquis at $30 for a 3 month supply. And I have no side effects I know of from this medication.

I find this conversation quite interesting. I have PAroxysmal AFib first discovered in 2016. Ablation in 2017 and Afib free for approx 4 yrs before experinceing short infrequent bouts that have morphed into a lot of PACs and longer AFIB spells. Once we had established that the ablation was successful my EP took me off Elliquis. I read and attend conferences on AFIB. It seems like the vast majority of cardiologists and EPs are wedded to the idea that DOACs should be standard forever after devloping AFIB, some even recommending it even to those folks who have their LAA occluded. After I started experienceing some short afib episodes in 2021 , I asked my EP when I should be concerned about anti coagulants, His answer is - take Elliquis if AF episode lasts longer than 4 hrs, which I do using the 'pill in a pocket' approach. There have been some recent studies which sorta susbtantiate my approach - check out OCEAN, OPTION, ARTESIA, and ALONE. All of these studies imply that DOACs do not reduce the risk of stroke in those who have undergone catheter ablation. There are some caveats so the studies don't apply to everyone but each uses data from large groups. I'm curious as to how the EP community will react to these studies.

@marybird So very glad to see your sober-thinking post. As we age, we seem to put more and more wishful thinking, dreaming, behind us. We have learned that our time and energy, not to mention our considerable life's learning, is best placed in front of intractable and recurrent problems that threaten our peace and longevity. As I have said in front of friends and family, I, a life-long competitive runner and Type A, with modest levels of achievement as an adult, went from a smug mature male to a pill-popping and rather chastened and frightened, wide-eyed older guy inside of a few minutes on an ER table with 12 leads running away from my torso and legs. It wasn't a kick in the teeth, but it was a stinging rebuke for losing self-awareness to the point where my sleep apnea, diagnosed as severe, squared me away...pronto. Like you, I now accept my mortality, and my energy goes toward making myself available to my ailing wife for as long as I can be of use to her, and for her sake. Our kids want their mom to be a grandma for a while longer, one of them with a brand new toddler girl at the ripe age of 45. And grandma wants to be around, and wants ME to be around. So, I have to adopt a realistic and mature approach to living. If the pills help me, I'll darned well take 'em. 😀

Not an expert here, of course, but maybe piecing together the group’s experience will help in answering your question. My Husband had a spike of BP while on Cyclosporin for a Lichen Planus outbreak. He had not been known to have Afib before, although both of his parents experienced Afib, and he was not taking meds for Afib. This BP spike may or may not have been the cause of the blood clot that moved to his eye, causing a stroke in his eye, and the resulting blindness. He had two cardioversions, both of which did not recover a steady heartbeat. Next came an ablation, and with that he was in rhythm.
We did get Eliquis from Canada for a number of years, until the US provided cost relief for Eliquis. In Canada we paid $274.11 for 168 tablets (how they packaged it). With the US changing the pricing structures on certain medications, we have now been able to order here in the States, and the cost is $119.00 for 180 tablets.
He signed up through AARP for an Optum Rx plan. He is on Medicare, and the plan costs $110 per month, and is taken out of his SS check.
I think you are doing well in searching the experience of others, as there are so many different answers as to whether or not to tale a blood thinner, and deeper, whether or not to take Eliquis. For us, Eliquis or not is not an option; it is a must. Secondarily, cost is a factor. And it is do-able compared to the past pricing.

@tyl411 thank you for your information. I would love to know how you get your Fit medication‘s Apixaban/Eliquis for such a small amount of money in the US. I also have AARP through United Healthcare. I don’t have the premium plan but I think I pay about $185 a month for that plan. Guess I’ll have to stick with Canada until my insurance company provides better cost effective measures.