Xarelto issue

This post meant to FOLLOW next (earlier one) on the list. Forgot that latest appears first!

Anyway, back from Austin I'm on Eliquis, indefinitely. Dr. Natalie directly told me that Xarelto is essentially the
same medication (differing in dosing only), so that they can be substituted. Reason I had this discussion is that
it turns out I have a substantial stash of Xarelto from an earlier Cardiologist Rx (back when my paroxsymal Afib
was first detected). Wanted to use this up now, if possible. So that would be ok with Natalie. However, now back
home I realize that my Xarelto stash is several years beyond nominal (2 Yr) expire date (by a few years). Anyone
have have knowledge of what the true "shelf life" of Xarelto actually is (apparently most drugs, if stored well, actually
store a lot longer than "advertised")?

You're right that most drugs do last well beyond their expiration dates, so your Xarelto might be just fine, but I doubt there's anyone who can tell you that for sure. It's not the kind of thing the manufacturer is going to spend money researching since it would be of no benefit to them at all.

Given the critical nature of the drug for you at this point, in particular since you have an isolated LAA, I wouldn't even think of rolling those dice. With an isolated LAA, missing even a single dose or two has been known to lead to stroke (per unpublished research by Dr. Horton at TCAI presented at HRS-2018). If I were you I would toss the old Xarelto and use only Xarelto within date. And personally, I would ask Natale to switch me to Eliquis since there's no stash anymore. I think once daily dosing with an isolated LAA is too risky. If you miss one dose of Eliquis, your coverage lapses for 12 hours, but if you miss one dose of Xarelto, your coverage lapses for 24 hours.

Incidentally, I also have an isolated LAA with a documented inadequate flow velocity. Although I received a Watchman in August 2018, I went a full year before I received it so I'm very attuned to the risks. I urge an abundance of caution. In fact, I'm still taking a half dose of Eliquis despite having a TEE showing the device is properly seated, leak free, and free of device-related thrombus. I intend to continue the Eliquis until my 1-year TEE this August confirms it is still leak and thrombus free.

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Carey

Given the critical nature of the drug for you at this point, in particular since you have an isolated LAA, I wouldn't even think of rolling those dice. With an isolated LAA, missing even a single dose or two has been known to lead to stroke (per unpublished research by Dr. Horton at TCAI presented at HRS-2018).

Incidentally, I also have an isolated LAA with a documented inadequate flow velocity. Although I received a Watchman in August 2018, I went a full year before I received it so I'm very attuned to the risks. I urge an abundance of caution. In fact, I'm still taking a half dose of Eliquis despite having a TEE showing the device is properly seated, leak free, and free of device-related thrombus. I intend to continue the Eliquis until my 1-year TEE this August confirms it is still leak and thrombus free.

What does an isolated LAA (left atrial appendage) mean exactly? How do you know when you have one - only after evaluation by Natale? Carey, I thought you went for yrs before you addressed your AF bec you are vagal & did not have episodes very often. I assumed your problem was not a big one. I don't know what a Watchman is either.

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Madeline
What does an isolated LAA (left atrial appendage) mean exactly? How do you know when you have one - only after evaluation by Natale? Carey, I thought you went for yrs before you addressed your AF bec you are vagal & did not have episodes very often. I assumed your problem was not a big one. I don't know what a Watchman is either.

It means that during the ablation the EP created burns around your LAA that isolated it, the same way they isolate your pulmonary veins. It's not something you have before an ablation. You know you have an isolated LAA because your EP tells you he did so.

Your recall of my history is more than a little "off" and saying my problem was not a big one would be a lot "off." :-) I'd be happy to refresh you on all that and what a Watchman is if you want to give me a call. Way too much typing here.