Eliquis

I realize that this is an A-fib forum, but readers should know that after being on Eliquis blood thinner for 6 years after a DVT I incurred a NEW
blood clot in the same leg.

We need to know the good and bad about Meds that Afibbers take for their AF, so thank you. There is a poster on this board that does not like Eliquis and takes Coumadin as he said it dissolved his clot whereas Eliquis did not.

I will stay with Eliquis. It is the choice of Texas Arrhythmia of Austin, Texas with Dr. Natale at the helm. Nothings ever perfect but human error as well as “crap” happens is always a possibility.

What smackman says.

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mwcf
What smackman says.

My cardiologist at Stanford was also sold on Eliquis. I can understand why. I was only switched to warfarin when they couldn't understand after 5 TEE's why it wasn't working. My situation was probably unique, a massive clot and weak ejection function. With testing, they could see exactly what it was doing, so it was gone in a week.

Note: Having stabilized on warfarin, I've never had a cardiologist since (including Hongo) ever suggest going back to Eliquis.



Edited 1 time(s). Last edit at 11/13/2018 10:03AM by jpeters.

The studies I looked at, which I don't have readily at hand to cite, judged the NOAC's as "noninferior" to warfarin. Hence they were not worse. As I recall, warfarin has been shown to reduce your risk by 50% (from where you start depending on CHADs, or a variant thereof, score). Hence none of the anti-coagulants reduce your stroke/clot risk to 0.

A friend's niece just had a very difficult and risky surgery to remove clots from her heart and lungs. Anticoagulants did not work. . She also has hemophilia. Discussing this case with a doc friend, he noted there are a number of different coagulation pathways or factors.

The NOACs are slightly better than warfarin, have a lower bleed risk, and have far fewer drug and food interactions. But their real advantage is predictability. Take the pill as directed and it just works. No INR testing, no dosage adjustments, and no diet considerations.

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Carey
The NOACs are slightly better than warfarin, have a lower bleed risk, and have far fewer drug and food interactions. But their real advantage is predictability. Take the pill as directed and it just works. No INR testing, no dosage adjustments, and no diet considerations.

Any glorious stories about aspirin in the works?

I know you've got a thing about warfarin vs. NOACs but I'm just stating the facts. I don't have a dog in the fight.

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Carey
I know you've got a thing about warfarin vs. NOACs but I'm just stating the facts. I don't have a dog in the fight.

I do have considerable personal experience with warfarin that I've shared. Facts never got in the way of altering your opinions.

2018 Oct 25

" In patients with atrial fibrillation, self-managed oral anticoagulant treatment was associated with a significantly lower risk of all-cause and ischaemic stroke compared to treatment with DOAC, whereas no significant differences were observed for major bleeding and mortality."

Anyway, this thread is about someone getting clots while on Eliquis, and it's not the first.



Edited 1 time(s). Last edit at 11/14/2018 11:01AM by jpeters.

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jpeters
I do have considerable personal experience with warfarin that I've shared. Facts never got in the way of altering your opinions.

I've never doubted your personal experience, but the plural of anecdote isn't data. Overall, all studies considered, the data indicate that NOACs are slightly better (ie, comparable) at stroke prevention and superior in bleed risk and drug/diet interaction. That's just a statement of the available data. It's not my opinion.

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Carey

I do have considerable personal experience with warfarin that I've shared. Facts never got in the way of altering your opinions.


I've never doubted your personal experience, but the plural of anecdote isn't data. Overall, all studies considered, the data indicate that NOACs are slightly better (ie, comparable) at stroke prevention and superior in bleed risk and drug/diet interaction. That's just a statement of the available data. It's not my opinion.

Overlooking the key factor....staying in therapeutic range. A weakness in NOAC's is actually lack of monitoring, although great hype to say it's not necessary.

Fortunately I was getting TEE's while on Eliquis, or I'd probably have suffered a major stroke which would be attributed to unknown factors.



Edited 1 time(s). Last edit at 11/14/2018 11:26AM by jpeters.

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GeorgeN
As I recall, warfarin has been shown to reduce your risk by 50%

Any Idea what risk Nattokinase would be, having a CHAD score of 2 or 3??

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jpeters
A weakness in NOAC's is actually lack of monitoring, although great hype to say it's not necessary.

That's no weakness. Quite the contrary, it's a strength. Despite no testing the NOACs still perform as well or better than warfarin, so what's the point of testing? It's not hype.

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jpeters

I know you've got a thing about warfarin vs. NOACs but I'm just stating the facts. I don't have a dog in the fight.

I do have considerable personal experience with warfarin that I've shared. Facts never got in the way of altering your opinions.

2018 Oct 25

" In patients with atrial fibrillation, self-managed oral anticoagulant treatment was associated with a significantly lower risk of all-cause and ischaemic stroke compared to treatment with DOAC, whereas no significant differences were observed for major bleeding and mortality."

Anyway, this thread is about someone getting clots while on Eliquis, and it's not the first.

Choose your analysis?


[benthamopen.com]


Summary of Doac Trials
Meta-analysis of the four above summarized DOAC-trials (RE-LY, ROCKET AF, ARISTOTLE, ENGAGE AF-TIMI) included as a group vs. dose adjusted warfarin for preventing stroke indicated that high dose DOACs significantly reduce the incidence of all stroke (ischemic or hemorrhagic stroke) and systemic embolism by 19% as compared to Warfarin (RR 0.81, 95% CI 0.73-0.91, P<0.0001) [21]. This benefit was mainly driven by a substantial 51% reduction in hemorrhagic strokes (RR 0.49, 95% CI 0.38-0.64, P<0.0001) [21].

Further, compared to warfarin, treatment with DOACs was associated with a non-significant 18%-reduction in ischemic strokes (RR 0.92, 95% CI 0.83-1.02, P=0.1) and a similar incidence of myocardial infarction (RR 0.97, 95% CI 0.78-1.20, P=0.77). DOACs use was associated with a reduction in all-cause mortality (RR 0.90, 95% CI 0.85-0.95, P=0.0003). Importantly, DOAC-treatment was associated with a significant reduction in incident intracranial hemorrhages (combination of hemorrhagic stroke, subarachnoid hemorrhage, subdural hemorrhage and epidural hemorrhage)

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Carey

I do have considerable personal experience with warfarin that I've shared. Facts never got in the way of altering your opinions.


I've never doubted your personal experience, but the plural of anecdote isn't data. Overall, all studies considered, the data indicate that NOACs are slightly better (ie, comparable) at stroke prevention and superior in bleed risk and drug/diet interaction. That's just a statement of the available data. It's not my opinion.

Currently, I am on warfarin but having incredibly hard time getting into range. changed my diet to iceberg lettuce, I take increased
amount of fish oils, gingko biloba, turmeric, garlic, bromelain, etc. I do eat natto (3 oz) every day. Looking for any help or advice
I can get on this subject.

thank you

Speaking of Eliqus. Does the science know what the risk of stroke is from a fib or a flutter if no blood thinners are taken vs. what is stroke risk reduced to if on Eliqus?

Robin - Glad your cruise was enjoyable.

This first link is a Reuter's Health summary June 2018 of a British Medical Journal study on this topic.
Has some relevant points in answer to your question...
[www.reuters.com]

These following links give similar comments and stats... just FYI

[www.ahdbonline.com]

[www.ahdbonline.com]

[www.eliquis.bmscustomerconnect.com]

Jackie

And it's always important to remember that stroke risk is usually given as an annual risk, and that means over time it's cumulative. So, for example, if you're a CHADS-Vasc 2 you have about a 1.9% risk of stroke occurring in any given year without anticoagulants. Well, that doesn't sound too bad, right? But if you do the math, a 1.9% annual risk of having at least one stroke over a 10-year period is about 17%. And over a 20-year period that rises to about 32%.

So without anticoagulants you've got about a 1-in-3 chance of suffering a stroke in the next 20 years. Anticoagulants will reduce that to about 12%, or a 1-in-10 chance.

One other thing that people very often overlook is that anticoagulants also greatly reduce stroke severity. So even if you do have a stroke while taking them, you're more likely to come out of it mentally and physically intact with anticoagulants than without.



Edited 1 time(s). Last edit at 11/19/2018 05:55PM by Carey.

Carey; Well, that doesn't sound too bad, right? But if you do the math, a 1.9% annual risk of having at least one stroke over a 10-year period is about 17%. And over a 20-year period that rises to about 32%

What kind of math are you doing--future values table?

Carey; So without anticoagulants you've got about a 1-in-3 chance of suffering a stroke in the next 20 years. Anticoagulants will reduce that to about 12%, or a 1-in-10 chance.

Anticoagulants cause hemorrhagic strokes;
A hemorrhagic stroke is bleeding (hemorrhage) that suddenly interferes with the brain's function. This bleeding can occur either within the brain or between the brain and the skull. Hemorrhagic strokes account for about 20% of all strokes, and are divided into categories depending on the site and cause of the bleeding:

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Elizabeth
What kind of math are you doing--future values table?

Simple probabilities. High school math.

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Anticoagulants cause hemorrhagic strokes

Actually, no they don't. Something else causes the bleed to start. Anticoagulants only delay the clotting.

But that's beside the point. I was just trying to answer her question.

Liz,

The maths I suspect was dreamt up by the drug company.
Even with a 30% chance of having a stroke, means a 70% of not having a stroke, still good odds.

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colindo
The maths I suspect was dreamt up by the drug company.
Even with a 30% chance of having a stroke, means a 70% of not having a stroke, still good odds.

Nobody dreamed up the odds. As for the math, I did the calculations on cumulative risk. It's basic high school level probabilities and it goes this.

If the annual risk of having a stroke is 1.9% then to figure the risk over a 10-year period you do this:

The probability of having at least one stroke = 1 - the probability of not having a stroke, so that's 1 - .019 = .981
The probability of not having a stroke in 10 years = (.981)^10 = .825
So the probability of having a stroke in 10 years = 1 - .825 = .175 or 17%


PS- If a 30% chance of having a stroke every year sounds like good odds to you, you should stay far away from casinos.

Unfortunately your math doesn't allow for any variables, the length of an AF episode, age and how often.

Age, etc. is built into the math by using CHADS-Vasc score of 2, which gives the risk factor of 1.9% I used. You can calculate other CHADS scores by substituting the risk for that score in lieu of 1.9%.

No one knows with certainty how length and frequency of afib episodes affect risk, so there's no way to account for it. Right now, the best data available data say that afib carries a significant risk even when there have been no episodes at all for a long time.

Carey said: No one knows with certainty how length and frequency of afib episodes affect risk, so there's no way to account for it.

May be, but frequency and length seem like the greatest factors determining stoke risk. It seems like the risk would be exponentially higher for someone having weekly episodes compared to someone having one, two hour episode per year.

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Ken
May be, but frequency and length seem like the greatest factors determining stoke risk. It seems like the risk would be exponentially higher for someone having weekly episodes compared to someone having one, two hour episode per year.

I agree that seems likely but I'm unaware of any data that actually examines that question.

Hi Ken - it may not be an issue when one is on Eliquis, but the many factors that help cause elevated blood viscosity aka hyperviscosity are known to be influences for clot formation and the duration or frequency of AF events can definitely be an influence. So knowing all those factors makes sense for overall health regardless of whether or not you are an afibber.



From a recent post....
Jackie
Re: Anxiety and Eliquis.......Still....
September 26, 2018
Mike - keep in mind for the short duration AF risk, this directly speaks to the hyperviscosity issue... and the tendency for "thick, sticky blood" to clot quickly. As the old adage quoted in the hemorheology literature.... "churn cream, you get butter, churn blood, you get a clot." So, going back to those tests that identify the risks for hyperviscosity including inflammatory factors, it makes sense to understand that unless one is aware of and managing the factors that allow blood to become hyperviscous, a few minutes of Afib could produce a clot more quickly. This would include fibrinogen levels as well.
[www.afibbers.org]
======


I didn't mention then, but in the hemorheology literature, the affects of 'sheer stress' were evaluated and found to be a contributor in areas of potential arterial blockages or just typical anatomical areas that create sheer stress.

Other factors influencing blood viscosity in addition to the fibrinogen mentioned include High Sensitivity C-Reactive Protein (HS-CRP), Homocysteine, Interleukin 6, LipoProtein (a), Ferritin and Hemoglobin A1C to rule out glucose handling issues- also causing hyperviscosity.

There are several archived posts on Clot Risk data... starting with this overview that discusses the hyperviscosity issue...
Silent Inflammation, Risk Marker for Stroke, or Heart Attack and Much More...
[www.afibbers.org]

Jackie

Here's something I found out about Eliquis.

[ethicalnag.org]