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?

Interested in more discussions like this? Go to the Heart Rhythm Conditions group.

My prescription for eliquis expired and er doctor says he cannot prescribe only the 6 weeks that he given me yet has told me I need to remain on for 6 months.
I have run out but have Xarelto. Can I take Xarelto until I can have my cardioligist see me and prescribe eliquis?

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@falvictorvet

My prescription for eliquis expired and er doctor says he cannot prescribe only the 6 weeks that he given me yet has told me I need to remain on for 6 months.
I have run out but have Xarelto. Can I take Xarelto until I can have my cardioligist see me and prescribe eliquis?

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Hi @falvictorvet and welcome to Mayo Clinic Connect. According to the FDA "Both Eliquis and Xarelto are known as factor Xa inhibitors, but they have some differences. Eliquis and Xarelto are both approved by the FDA for prescription use and are available in brand name only. No generic is available yet for either drug; however, a generic Eliquis should be available soon."

What's the difference – https://www.singlecare.com/blog/eliquis-vs-xarelto/

You will see that I moved your post to a discussion that discusses stopping Eliquis. I did this so that you can connect with other members on Connect that are currently taking the medication to see if anyone has ever received permission from their physician to use them interchangeably.

Did you ask you ER physician if you could take the Xarelto as a substitute if you cannot get in to see your cardiologist? Also, have you contacted the nurse at the cardiologist to see if they can advise?

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My ablation procedure was at least 16 years ago. I am now 81. I was taken off of all heart medicine and NEVER put on a blood thinner. I take one 375 mg. aspirin a day and I take it with food to protect my stomach. I usually take it with the evening meal. If I'm going to have wine, I skip the evening aspirin. If I KNOW I'm going to have wine in the evening because maybe I'm going out or to a party, then I take my aspirin with breakfast. I do take 2 blood pressure medicines, 20-12/5 mgs. of Lisinopril w/Hydrochlorothiazide and 2.5 mgs. of Amlodipine. I take nothing else other than multi-vitamins.

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@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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Thanks. I am on Eliquis for more than two years but did not know about Andexxa. Hopefully, it is available now.

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@kancha

Thanks. I am on Eliquis for more than two years but did not know about Andexxa. Hopefully, it is available now.

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From an excerpt at Harvard.edu…….."The wait is over for an antidote to stop rare uncontrolled bleeding linked to some newer blood thinners. The FDA approved andexanet alfa (AndexXa) on May 3, 2018. It's the first and only antidote to reverse bleeding in people taking apixaban (Eliquis), rivaroxaban (Xarelto), or edoxaban (Savaysa).

Another newer blood thinner — dabigatran (Pradaxa) — already has an approved antidote called idarucizumab (Praxbind). A dose of vitamin K is used to reverse the action of warfarin (Coumadin), a blood thinner used routinely for more than half a century and, until recently, the only such option for most people."

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@dsisko

A couple of concerns. One is that I heard that in some covid cases, the body throws off large amounts of blood clots. I’m assuming that the Eliquis would be helpful if I got covid and clots. Another is that I am on a very low dose of tamoxifen which has a small risk of clots. Am concerned that going off the Eliquis could have a negative impact from the tamoxifen.

I had not taken any medications except short term until I started with Eliquis and losartan. I was adamantly against going on them at the time because of having generally good health and now that I was convinced to take them, I am concerned about going off of them. I feel a little crazy about the whole thing.

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I was diagnosed with AFIB and immediately put on Xarelto. Guess I'm one of the lucky ones as I had no side effects…….at least none that I was aware of. When medication did not stop the AFIB, I had an ablation a little over 2 years ago. Since then, I have had two very minor "breakthroughs" which only lasted a very short time. I also wore a ZIO patch twice and both times, two "silent" episodes of AFIB were recorded. I've been told by my cardiologist that "sometime" in the future, I MAY need another ablation. I'm not thrilled with that, but understand it's very common to require more than one. Because AFIB is NOT curable, I am choosing to remain on the Xarelto for the protection it provides. I worry enough about the AFIB, I'm not going to add the fear of having a stroke on top of that. It is a very personal decision between you and your cardiologist. I wish ALL of us luck because "living" with AFIB is a nightmare.

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@rubywitch67

I was diagnosed with AFIB and immediately put on Xarelto. Guess I'm one of the lucky ones as I had no side effects…….at least none that I was aware of. When medication did not stop the AFIB, I had an ablation a little over 2 years ago. Since then, I have had two very minor "breakthroughs" which only lasted a very short time. I also wore a ZIO patch twice and both times, two "silent" episodes of AFIB were recorded. I've been told by my cardiologist that "sometime" in the future, I MAY need another ablation. I'm not thrilled with that, but understand it's very common to require more than one. Because AFIB is NOT curable, I am choosing to remain on the Xarelto for the protection it provides. I worry enough about the AFIB, I'm not going to add the fear of having a stroke on top of that. It is a very personal decision between you and your cardiologist. I wish ALL of us luck because "living" with AFIB is a nightmare.

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My ablation was 12 years ago. I too was told I may need another. I had one breakthrough two summers ago when I had to walk 3/4ths of a mile in 101 degree weather. At age 78, it nearly killed me. My car battery had given out and I was close to my doctor's office which is where I was headed anyway, so I just left the car and walked. My blood pressure was up at 145/88 and my heart rate was 101 after sitting for about 15 minutes. They wanted to send me to the hospital but I would not go. I had a feeling it would not last long and it didn't. In less than an hour I was back to normal. I take a full strength aspirin every day with food. Sometimes I take two. One at breakfast and another at dinner. I have a friend who has been having intermittent A/fib for about ten years now. She too takes only aspirin. It's true that heart failure, stroke and dementia are possibilities but I don't worry about any of them even though they may happen. My friend says she sits down (remaining in an upright position) and takes deep breaths and her A/fib goes away fairly quickly every time. She says that if it becomes prolonged, she will seek treatment. Almost every one of my gal pals has permanent A/fib and they all take medication. They're all older than I and so far none of them has had a stroke. Hopefully I won't have another episode nor will you.

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@predictable

Hi, @rubywatch67. Two quick points in response before I run off and pick up our dinner at a drive-in and bring it home. First, I am familiar with Andexxa and Praxbind, but both of them encountered problems that delayed their release by the FDA for some time. If they are now fully approved and recommended by the FDA, that's good for everybody else to know. Second, I don't find Andexxa to be readily available. Last November, for example, I was in two hospitals in connection with a hypertension emergency, and as is my custom, I asked about the availability of Vitamin K and Andexxa. The Andexxa was not in the ready supply of either hospital. The Vitamin K solution was available in both. I am especially careful about this since my friend died of a hemorrhagic stroke four years ago because the hospital to which the ambulance took him following an accident had no Vitamin K on hand. I don't find it difficult to deal with foods (mostly vegetables) that provide Vitamin K in various amounts, because I have several years experience in consuming vegetables in fixed amounts and of regular types. Using a common diet, I achieve successful anticoagulation by minor modification of the doses of Vitamin K that I take. Your suggestion that patients needing anticoagulation medications are doomed to extreme complications if they choose Coumadin is overwrought. It is good, though, that they may find comfort in learning from you what questions they should ask when deciding on a medication. Martin

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Hi Martin! Considering how highly I hold your experience and advice, I was a bit upset by your reply to MY personal opinion of Coumadin and why I chose, personally, not to use it. I DID make a list of a few foods that would need to be eaten with some caution due to their higher Vitamin K content. I included that list because when I was discussing MY choices for an anticoagulant with my cardiologist, he gave me this list and it was a surprise to me! I posted that list for people, who like me, were faced with choosing an anticoagulant for the first time. I didn't, in any way, allude the choice of Coumadin spelled DOOM! For you to write that "Your suggestion that patients needing anticoagulation medications ARE DOOMED TO EXTREME COMPLICATIONS IF THEY CHOOSE COUMADIN IS OVERWROUGHT." That statement goes a LONG way over the line of what I actually DID say. I know you have been on Coumadin for a long time now, as have a number of my friends. A couple whom said it DID take them awhile to get comfortable with the changes in diet and the monthly trip to the clinic for level checks. But they, AND you, made those adjustments and are very happy with the results. The high availability of an antidote was, for my friends, a real selling point as some of the new anticoagulants were still working on antidotes, and yes, there WERE some hitches along the road to FDA approval for those antidotes. I have no doubt you are now aware that FDA approved antidotes are readily available for all the "new" anticoagulants on the market. I wish you had included my final opinion which said: "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."
Linda

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@rubywitch67

Hi Martin! Considering how highly I hold your experience and advice, I was a bit upset by your reply to MY personal opinion of Coumadin and why I chose, personally, not to use it. I DID make a list of a few foods that would need to be eaten with some caution due to their higher Vitamin K content. I included that list because when I was discussing MY choices for an anticoagulant with my cardiologist, he gave me this list and it was a surprise to me! I posted that list for people, who like me, were faced with choosing an anticoagulant for the first time. I didn't, in any way, allude the choice of Coumadin spelled DOOM! For you to write that "Your suggestion that patients needing anticoagulation medications ARE DOOMED TO EXTREME COMPLICATIONS IF THEY CHOOSE COUMADIN IS OVERWROUGHT." That statement goes a LONG way over the line of what I actually DID say. I know you have been on Coumadin for a long time now, as have a number of my friends. A couple whom said it DID take them awhile to get comfortable with the changes in diet and the monthly trip to the clinic for level checks. But they, AND you, made those adjustments and are very happy with the results. The high availability of an antidote was, for my friends, a real selling point as some of the new anticoagulants were still working on antidotes, and yes, there WERE some hitches along the road to FDA approval for those antidotes. I have no doubt you are now aware that FDA approved antidotes are readily available for all the "new" anticoagulants on the market. I wish you had included my final opinion which said: "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."
Linda

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@rubywatch, if you are correct today — disputing a statement I made six months ago — then I'll be glad to agree with you. The antidotes Andexxa and Praxbind for anticoagulants used to treat A-fib were NOT readily available, as I stated in December 2020. Although approved by the FDA some months before that, they encountered manufacturing and distribution problems that delayed their availability, and in fact, Andexxa was still not "readily available" in the two hospitals I entered for treatment. At the time that you posted your first message (December 6, 2020) you said "All the anticoagulant choices are good and safe." My personal experiences at that time convinced me that statement was wrong. I hope time and progress has now made your statement correct. I'll not rely on your assurances, however; instead I will continue to ask clinics and hospitals I encounter for treatment whether they have my anticoagulant "readily available" if needed, and I hope all A-fib patients will do the same for their own safety. My motive simply is driven by the unpleasant memories of my friend who died in a helicopter while being transferred from a "modern" hospital that didn't have his antidote "readily available." I sang at his funeral. Martin

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