Now I am really afraid to stay on Eliquis....today was an eye opener

I don't think this impacts what happened, but my 83 year brother in law, Craig, has a form of Parkinson's disease, where he moves VERY slowly and has shaky hands, etc. Yesterday afternoon, he must've tripped on his own feet and fell down hard on his side, in his kitchen. Tonight, he is in ICU on a ventilator, has had his kidney and spleen removed, and has still not woken from the two operations they did to try to get his blood to clot and contain it. He had something like 14 units of blood through transfusion and it's questionable as to how this is all going to turn out.

He is on Eliquis - and apparently, that's been much of the problem. He had to be moved to a trauma center as he was going into shock when the ambulance got to their house, and he had internal bleeding. From what I've heard, they see a number of cases of people on Eliquis who they have trouble handling after a fall or accident, as there still is no real antidote to this drug. I thought there was!

While I seem to tolerate Eliquis w/o a problem, this experience with my brother in law and the other examples I heard about in the hospital make me very uncomfortable staying on this medication....

I know there is the Watchman and the Lariat as options, but how safe and effective are they really? And how close are we to an antidote (is that the right word?), for Eliquis, to stop the bleeding that can occur after an accident, fall, etc.?

Scary stuff.....Barb

How about good ‘ol Warfarin - an anti coag that’s been around for umpteen years.

This garbage that pharma hypes about not being able to eat certain foods while on Warfarin is just that - garbage. They don’t like us to pay next to nothing for an effective, long track record drug. My husband and I are both on Warfarin; no side effects, know there is an antidote for situations such as your brother-in-law’s and easy on our pocket books. We are consistent in what we eat. I am plant-based and devour a big bowl of salad every night and my dose is adjusted accordingly.

We have our INR checked every 5-6 weeks, staying in the 2.4 to 2.6 range.

Parkinson’s is one nasty disease, and I won’t inquire why they removed major organs simply from a fall. My maternal granmother had it, and my cousin died of it two years ago. Good luck to you and yours.

First, there IS a reversal agent for Eliquis. I don't know why Barb's brother in-law didn't receive it, but by the sound of it the injuries were serious enough that they would be life threatening even without an anticoagulant being involved.

Second, Eliquis is safer than warfarin. There is no "big pharma" conspiracy here.

I'll write a more complete response later when I have time, but in the meantime, there's nothing scary about Eliquis.

Do you know the name of the reversal agent, Carey? I believe they used one, but said it wasn't all that effective.

I'm back to the hospital now to see what his status is. I do think this whole thing warrants more discussion - at least for me it does. I have NO interest in warfarin, but I do have an interest in getting off blood thinners all together, since I no longer have Afib and my TEE's were good...

To be continued....Barb

Hasn't Eliquis such a short half life that missing a dose may mean it's no more effective?

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tobherd
Do you know the name of the reversal agent, Carey? I believe they used one, but said it wasn't all that effective.

I'm back to the hospital now to see what his status is. I do think this whole thing warrants more discussion - at least for me it does. I have NO interest in warfarin, but I do have an interest in getting off blood thinners all together, since I no longer have Afib and my TEE's were good...

It's called Andexxa (generic name: andexanet alfa). It reverses both Eliquis and Xarelto. There's a separate reversal agent for Pradaxa.

Since they had to remove his spleen and kidney, that was obviously a very bad fall. People underestimate falls, but I spent 15 years as an EMT and falls in and around the home were some of the most common calls we dealt with. I've seen broken arms, legs, hips, and ribs, fractured skulls, internal injuries like your brother in-law suffered, a nose literally ripped off, and even deaths. Both the kidneys and the spleen are very vascular organs. You rupture a spleen or kidney and you're going to bleed a LOT, so for him to need transfusions isn't surprising given that he must have ruptured both.That would have been true even without the Eliquis.

The thing is, warfarin has a much longer half life than Eliquis (20-60 hours vs 12 hours), and vitamin K takes upwards of 12 hours to reverse it, so it's not in the least bit safer than Eliquis. But the reality is that people dying from bleeding due to anticoagulants is really a pretty rare thing. A lot of people tend to overestimate the danger. External bleeding can almost always be controlled with direct pressure, and internal bleeding can almost always be controlled with surgery if you can get to (an appropriate) hospital in time. The bigger danger is bleeding within the brain. It doesn't take a lot, and surgery can't always stop it.

As for stopping anticoagulants, what's your CHADS-Vasc score? That's the thing that's going to determine how practical it is for you to stop anticoagulants. If you're not sure, there's a calculator here. And yeah, there are LAA occlusion devices like the Watchman (I have one), but Medicare and insurance companies so far aren't paying for those unless you can't tolerate anticoagulants. I think that will change in the next few years as they come to realize that an occlusion device is a hell of a lot cheaper than a stroke,



Edited 1 time(s). Last edit at 02/05/2019 04:51PM by Carey.

As for stopping anticoagulants, what's your CHADS-Vasc score?

Isn't the "female" point gone now?

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katesshadow
Isn't the "female" point gone now?

Yes, it is.

According to my brother in law's doctor, it takes 48 hours to clear the body....I"m not sure that they had an effective reversal agent, and am not even sure what the status of that is....

Barb

Do you even have a CHAD score if you no longer have Afib? I am a 66 year old female who has not had Afib for over 4.5 years, since my 'touch up" ablation with Dr. Natale. I did have a LAA ablation initially, but have been fine since the touch up.

What else matters in terms of calculating your (my) risk?

Barb

Everyone has a CHADS score even if they no longer have afib. You can ignore the point you get for being female, but you get at least one for being over 65. If that's the only point you get besides being female you could probably stop anticoagulants.

HOWEVER....

What really concerns me is your mention of an LAA ablation. If your LAA was isolated during your ablation, did they do a TEE afterwards to measure your LAA flow velocity? And were you told that your flow velocity was sufficient that you could stop taking anticoagulants? If you don't know the answer to those questions or the answer is no to either one, you absolutely cannot stop anticoagulants. The only way you can stop anticoagulants if you have an isolated LAA and inadequate flow velocity is to have your LAA occluded with a device such as a Watchman. Please don't even consider trying to do so until you're sure what your status is.

Carey - I've had 4 TEE's since my LAA isolation. (one after my first ablation, on after my "touch up" ablation, then another one as I seemed to be pretty close to the "line", I believe....My most recent one was done last August, and it showed the peak emptying LA appendage velocity was 41.4 cm/sec. Normal left atrial size. Peak filling LA appendage velocity is 67.4 cm/sec.

TEE was performed at Montefiore hospital and read by the doctor that was requested by Dr. Andrea Natale, as he felt that doctor read the test most accurately.

It seems they felt the numbers were good, but were still hesitant..and Dr. DiBiase (at Montefiore), suggested I have it done one more time.

Not sure what to do at this point.....Barb

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tobherd
Not sure what to do at this point.....Barb

Easy. Do what Di Biase recommends. I would trust him if I were you.

Hi Barb,

Ditto what Carey said ... get that last TEE at Montefiore with your results to-date being still close to the line of being okay regarding your LAA mechanical function after your initial and touch-up LAA isolation procedures.

Then, we can help you make the decision for a Watchman, if that seems the best long term move for maximum safety and freedom from having to remember anything critical at all ... like don't dare miss a dose of Eliquis after LAA-isolation, if your LAA mechanical function is still only borderline robust enough, at best.

Cheers!
Shannon



Edited 1 time(s). Last edit at 02/06/2019 02:14AM by Shannon.

Shouldn't anyone who has Afib have an automatic "1" on the CHADS score?

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katesshadow
Shouldn't anyone who has Afib have an automatic "1" on the CHADS score?

Nope. See: <[en.wikipedia.org]

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katesshadow
Shouldn't anyone who has Afib have an automatic "1" on the CHADS score?

Yes, if you are female. However the threshold is increased by one point for females uniformly in the revised 2019 standard, so there is no penalty for females,



Edited 1 time(s). Last edit at 02/06/2019 10:37AM by safib.

Now I'm confused. When did "female" get dropped from the factor list?

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PBqltbook
Now I'm confused. When did "female" get dropped from the factor list?

[www.thecardiologyadvisor.com]

My flow velocity was fantastic after my LAA was isolated but I had no A Wave. My Chad score is actually 1 or less. I say this because I do have very minor BP issues. Besides that, Going by the Chads scoring system I shouldn’t have to take a anticoagulant. A Waves is not part of the Chad scoring criteria unless I am not understanding.

Anyway, My point is your velocity can be excellent after LAA isolation but a missing A wave blows up my tee results. So, I take Eliquis for life and I despise it because of cost and the pharmaceutical industry screwing the common man.
Why is Eliquis $415 a month in the USA but approx. $130 in Canada AND why is 2.5 mg of Eliquis the same price as a 5 mg pill? Pisses me off big time.
I am a common man and do not understand A waves etc.
I am a darn good retired EE but not versed in field of Cardiology.

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smackman
Why is Eliquis $415 a month in the USA but approx. $130 in Canada

Ask Congress why they prohibited Medicare from negotiating drug prices and you'll have the answer.

Meanwhile, you can get Eliquis for $165 per month from planetdrugsdirect.com. Completely legit and reputable. I've used them for a couple of years.

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Carey

Why is Eliquis $415 a month in the USA but approx. $130 in Canada

Ask Congress why they prohibited Medicare from negotiating drug prices and you'll have the answer.

Meanwhile, you can get Eliquis for $165 per month from planetdrugsdirect.com. Completely legit and reputable. I've used them for a couple of years.

Can anyone order from there?

Also, call me dense, but if Afib causes your blood flow to slow or stagnate, why is it not considered in the CHADS score?

Quote
Carey

Why is Eliquis $415 a month in the USA but approx. $130 in Canada

Ask Congress why they prohibited Medicare from negotiating drug prices and you'll have the answer.

Meanwhile, you can get Eliquis for $165 per month from planetdrugsdirect.com. Completely legit and reputable. I've used them for a couple of years.

I know you are joking when you say ask Congress. Maybe I will ask them to explain their luxurious life style on there salary and living in one of the most expensive cities in the US plus living in Mansions with walls and armed personnel by their side.

It’s called kickbacks. I am almost 61 and because I am disabled, my Medicare Supplement is over 2x higher than a 65 year old. I am not disabled from having AFIB; I had a bad car accident in 2003. Anyway, Congress really reeks with ......., Get the picture.

Quote
katesshadow


Also, call me dense, but if Afib causes your blood flow to slow or stagnate, why is it not considered in the CHADS score?

The thresholds are based on nonvalvular AF population. So the test is based on AF. There is interest in using the score for other populations

So just being in afib itself is not a risk factor?

How is the Chads score figured with someone like me? I have minimal high blood pressure issues(like 125/78 taking 25 mg of ER Metoprolol 1 time a day).
No AFIB issues since last Ablation in June 2016
61 years old
1 stent put in Jan 2012.
Great flow velocity after LAA was isolated according to TEE in December 2016 BUT NO A WAVE DETECTED.

Can a Chad’s score be accurately figured on Cases like mine?

Quote
smackman
How is the Chads score figured with someone like me? I have minimal high blood pressure issues(like 125/78 taking 25 mg of ER Metoprolol 1 time a day).
No AFIB issues since last Ablation in June 2016
61 years old
1 stent put in Jan 2012.
Great flow velocity after LAA was isolated according to TEE in December 2016 BUT NO A WAVE DETECTED.

Can a Chad’s score be accurately figured on Cases like mine?

Sure. The stent means you've got vascular disease so that's 1 point. If your pressure would be over 130/80 without the metoprolol that would be another point.

So you're either a 1 or a 2 depending on BP without the metoprolol. When you hit 65, you'll get another point.

Quote
katesshadow
So just being in afib itself is not a risk factor?

Yes, it's a risk factor but it's not considered in the scoring system. CHADS assumes you have (or had) afib.

Since we're discussing many topics within this thread, I'm gonna be bold and ask a short question related to NOACs.

(Hope no one believes I'm trying to railroad the original poster's subject.)

Anyone have the latest on Lupin’s generic Eliquis?

Thank you.

/L

Not me, but thanks for alerting us to the fact that a generic apixaban has been approved by the FDA. Somehow I missed that news.

My insurance covers Eliquis at no charge because it's a preventative med, but if I were paying for it I wouldn't hesitate to get the generic.

Update...I spoke with Salwa in Dr. Natale's office today, about this topic we've been discussing. She said that they no longer use the CHAD score to determine whether or not to stay on or get off of the blood thinner -but now rely on the TEE. She was going to talk with Dr. Natale, who will be coming to the NY area soon, to see if I can either make an appt or talk with him further. I believe she said that the doctor who read my most recent TEE (and who was requested to read it by Dr. Natale), said I could get off of Eliquis. I'm wondering if I understood her correctly....

So I am waiting to hear back from her. In the meantime, I have a question about the CHAD score....do you get a point for high BP if it is well controlled with medication and is not high now? It tends to be around 115 or 120/78 or so...

OK...thanks for all of your replies. I think this is a very important discussion, especially after seeing what happened to my brother in law.

Good night all ~ Barb

Hi Shannon - are my numbers borderline? When I spoke with Salwa today, she indicated that the doctor who read my TEE report determined that I could get off of Eliquis...or at least that's what I think she said. And is there an effective reversal agent for Eliquis or not? If so, it sure didn't do a good job for my brother in law...who was brought to the hospital he's in because it's a trauma center and i think because they're supposed to be able to help with something like this.

If there's an effective reversal agent, that at least is somewhat reassuring, but I'm not sure that would be effective if you were to bang your head....brain bleeds don't have a good record for recuperation.

Good to hear from you. I hope you and Magdalena are doing well.

Warmly ~ Barb

Quote
tobherd
In the meantime, I have a question about the CHAD score....do you get a point for high BP if it is well controlled with medication and is not high now?

Yes. You get a point for hypertension even if it's well controlled. I get one for that.

“Second, Eliquis is safer than warfarin. There is no "big pharma" conspiracy here.”

That’s your opinion. Just its prohibitive price speaks volumes.



Edited 1 time(s). Last edit at 02/07/2019 09:43AM by Catherine.

Be patient, it’s just a matter of time before Lawyers get involved.

Quote
Catherine
That’s your opinion. Just its prohibitive price speaks volumes.

No, it's not my opinion. It's the data.

The data at this juncture is unreliable. Eliquis has not been around long enough to yield dependable data, whereas my INR nurse has patients in their eighties who’ve been on Coumadin for 20-30 years.



Edited 2 time(s). Last edit at 02/07/2019 01:29PM by Catherine.

...besides, why would any drug company release a life altering/threatening medication first then years later an antidote? Greed?

FDA approved Eliquis in 2012;
Andrexxa, the antidote, approved in 2018. Really?

Quote
Catherine
...besides, why would any drug company release a life altering/threatening medication first then years later an antidote? Greed?

FDA approved Eliquis in 2012;
Andrexxa, the antidote, approved in 2018. Really?

Wht are you saying that Eliquis is a life altering/threatening medication?

I am new to Afib. Doc prescribed Eliquis. Reading posts like this freak me out and I want to know if. I need to get with my Dr and find out why she would prescribe such a dangerous drug without even a hint that there are issues.

Life altering because it prevents clots (strokes); life threatening because of bleeding as in the OP’s case.

The NOACs (Eliquis, Xarelto) are NOT dangerous. Warfarin is actually more dangerous. The reversal agents for the factor Xa anticoagulants probably even work faster than the Vitamin K antidote for Warfarin (12+ hours). The downside is cost. Eliquis costs more than warfarin ($100s/month vs $10s/month, probably) and if you ever had to have the Eliquis reversal agent then get ready for a multi-thousand dollar fight with your insurance company over it. Very unlikely event, however.

I think a lot of the fear stems from the idea of uncontrolled bleeding and anticoagulation. Well, uncontrolled bleeding can kill you whether you're anticoagulated or not. Also, bleeding can be controlled even when you are anticoagulated. It's perfectly fine to be nervous about it. I was. Here are some things you can do to perhaps make yourself less nervous: 1) Carry a medication card in your wallet or wear a medical bracelet indicating your anticoagulation status. EMTs or ER staff will find this. 2) Carry a first aid kit with you. If you're engaged in outdoor activities potentially far away from population centers then you can treat cuts or puncture wounds. 3) Get some quick-clot. That's what the Army uses for field dressings. Doubt you'd ever use it but it's cheap, available in drug stores or WalMarts and if it gives you piece of mind, then it's worth the few bucks you spend on it.

Kate, don’t freak out, we’re all in the same boat. I can’t speak for the others, but even though I’m into my third year with P- AFib, still, having it inexplicably come on freaks me out.

Have you snooped around this website? Go to [afibbers.org] Some amazing information that has helped me a lot.

Plavix has ongoing lawsuits, even though it’s application is a little different; Xarelto has ongoing lawsuits. Eliquis, not yet.

Here is the sutuation with Pradaxa.

Pradaxa Lawsuit – Pradaxa Legal Claims & Lawsuit Information. At the time of its 2010 approval, blood-thinner Pradaxa had no available antidote. It was responsible for serious bleeding events, including death in thousands of patients. Since it was introduced, Boehringer Ingelheim has faced thousands of Pradaxa lawsuits ...

Pradaxa had issues with GI bleeds, yes. Eliquis is safer because of the 2x/day dosing.

Catherine, you're tossing out a lot of fear mongering misinformation. I'm not even sure where to begin but wolfpack made a good start on it.

A few points:

1- OP's problem was major injury to his spleen and kidney, and that's guaranteed to produce massive bleeding even without an anticoagulant. Calling Eliquis life threatening is serious fear mongering.

2- Lawyers file lawsuits. It's what they do to make money and the existence of lawsuits says absolutely nothing about the safety or efficacy of a drug. It's utterly meaningless and most drugs do end up producing lawsuits. You'll note that those lawsuits are always aimed at patented drugs, not generics. That's because the lawyers only go for the deep pockets. They couldn't care less about public safety.

3- Strokes represent a much greater threat to people with afib than bleeds. Anticoagulants and stroke are a risk/benefit balance and always will be.

4- Eliquis and Pradaxa have been on the market for years and their safety profiles are well understood. The data are not "inadequate."

I could go on but really, please try to balance your comments and use more facts than scare tactics. There are people reading these threads who are new to afib and don't know who or what to believe. If you're going to tell people a drug is dangerous then you need to be providing objective evidence to support that claim. Vague statements about lawsuits, "inadequate data" and scary anecdotal stories aren't facts.

One additional comment on risk of blood clots with Afib. On the question of, does someone with controlled afib need to be on an anticoagulant, my EP replied that at that time (about 3 years ago) studies had not been able to show a statistical difference in the risk of clotting between controlled and uncontrolled populations.

I appreciate the clarifications. I was exaggerating when I said "freaking" but it does somewhat alarm me to read that a medicine that I was told I needed could also do great harm. I knew there was a bleeding risk, but was told the benefit outweighed the risk (at least for now).

Anyway, people (and this is not directed at anyone in particular) do need to stick with facts.

I'm still in the learning phase and while some things are trial and error, I'm not gonna be a Guinea pig with a medicine 😕. I read the OP and it does seem that the Eliquis is not the main problem. I hope he is doing better.

Carey, go back and read the OP’s post and stop inserting your script into what YOU think has happened to him.

I don’t appreciate your accusing me of “fear mongering” and censoring the forum. Instead, I would have hoped you would have addressed some of the points I made; for example, you bandy about the positive research and data, etc. on a drug that is comparatively new, and you express no concern about it being dispensed without an antidote.

I might have mentioned, in a past post, when my husband was hospitalized after valve replacement surgery, the gentleman in the next bed was bleeding internally and for fwo days his doctors were unable to find the source. He was scheduled for exploratory surgery the next morning. He was on Xarelto and they had no antidote.

Carry on.

GaryPNW - On the risk of blood clots and controlled Afib..... There are several factors that help contribute to elevated blood viscosity aka hyperviscosity and there are corresponding lab tests that can help one monitor the status of what makes blood hyperviscous also called: thick, sticky blood.

When I began my AF journey, the only anticoagulant available was warfarin/Coumadin. I tried that but had significant difficulty in maintaining proper range consistently because of a low blood platelet count so I embarked on research to find what could be done to lessen the causes of hyperviscosity and I managed to stay clot free even during very extended periods of AF with the use of nattokinase and other supplements...plus diligent marker testing.

I'm not suggesting you follow this approach for all of the obvious reasons... but you can learn more by doing a search in the archived posts on nattokinase which is what I used to stay safe before and after my ablation in 2003 - plus also reading through these specific posts:

Start with this on " Lumbrokinase for Clot Risk Prevention "
[www.afibbers.org]
and then at the end of the report are the other links to posts on this same topic...on the risk factors which are important to assess for your specific situation.

* Silent Inflammation

* Sticky, thick blood - Risk of Stroke and MI

* Clot Risk

Best to you,

Jackie

Jackie. if I had the courage, I would spin off Warfarin as I don’t think it is a benign medication, as well.

I have akways relied on diet, supplements and lifestyle changes versus drugs to treat my cancers and now my AFib. That’s why when I landed on the “Strategy” section of this forum, it was right up my ally. I attribute the protocol in the Strategy responsible in controlling my ectopics and shortening the AFib episodes.

I always question my doctors, and the meds they dispense.