Eliquis 2.5mg dosing

I know the standard dosing for eliquis is 5mg twice per day. Does anyone know if taking half of the dose, 2.5mg twice per day, is effective still? Or is only the full dosing what is promoted?

Sorry for the questions. I'm new to all this. I appreciate you all!

5 mg is the normal dose for afib. The 2.5 mg dosage is used for:

● Age ≥80 years
● Body weight ≤60 kg (132 lbs)
● Kidney dysfunction
● Prophylaxis against DVTs

I take 2.5 mg off-label as a substitute for aspirin (I have a Watchman and the Watchman protocol is aspirin for life).

Thanks Carey!

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Carey
5 mg is the normal dose for afib. The 2.5 mg dosage is used for:

● Age ≥80 years
● Body weight ≤60 kg (132 lbs)
● Kidney dysfunction
● Prophylaxis against DVTs

I take 2.5 mg off-label as a substitute for aspirin (I have a Watchman and the Watchman protocol is aspirin for life).

There are exceptions. I am 62 and definitely weigh over 200. My LAA is isolated resulting in no P Wave. Everything else is good. I amp prescribed 2.5 mg Eliquis 2X a day and 1 81 mg aspirin. This is by Dr. Natale. The aspirin is for a stent and the Eliquis is for no P wave after LAA was isolated. I

Yeah, we're kind of similar. The P wave was a factor for me as well. Both of us are off-label judgement calls by Natale. I'm good with it.

Did you always have no p wave or is this a result of the ablation? I’m thinking about getting my first pv isolation. Will I risk having to get an LAA isolation? Not sure how that works. Thanks.



Edited 1 time(s). Last edit at 02/16/2020 02:28PM by cirenepurzalot.

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Carey
Yeah, we're kind of similar. The P wave was a factor for me as well. Both of us are off-label judgement calls by Natale. I'm good with it.

My only concern is cost but they are working with me on that. They have cut my cost in half with a $2 pill cutter which I already have. 😁

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cirenepurzalot
Did you always have no p wave or is this a result of the ablation? I’m thinking about getting my first pv isolation. Will I to ask having to get an LAA isolation? Not sure how that works. Thanks.

I'm pretty sure Carey & Smackman's lack of "p" wave is due to LAA isolation. A PVAI (Pulmonary Vein Isolation Ablation) should not have this issue. There are many EP's who are not trained to do LAA isolation. Generally, significant LAA work is done on a follow up ablation. This is the conservative approach - see what you can get done without doing the LAA, because of the consequences. Certainly, not everybody needs this. The more you are in the long-standing persistent atrial fibrillation category, the more likely LAA work will be needed. The point of going to the best EP you can manage is that they will have the skills to do more, if needed.

Poster Mike F, from Scotland, had afib (all this from memory) for 20+ years. It is familial. He used flec to control it for much of that time, again from memory, a base dose to keep in NSR and an additional loading dose to convert when he went out of rhythm. In August 2018, he had an ablation done in Bordeaux by Prof Jais. I believe Jais only needed to do a PVAI. However, even though Mike had afib for many years, his actual frequency of afib was relatively low. So his strategy of minimizing his time out of rhythm, using meds, was successful in minimizing the amount of work needed in his ablation. In Mike's case, he noticed his afib control trajectory was deteriorating, hence his decision to get an ablation. If he weighs in, he can obviously tell his story better than I can. You don't necessarily need an ablation right at the beginning of your afib journey, if you can minimize the AF burden through lifestyle and/or meds. If your AF burden is material, and you can't come up with a way to reduce it (which is partially luck of the draw), then it makes sense to get an ablation sooner rather than later. Waiting will likely make the amount of work required much more significant.

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GeorgeN
I'm pretty sure Carey & Smackman's lack of "p" wave is due to LAA isolation.

Actually, in my case I think it's mainly due to the multiple ablations, two of which were fairly extensive. The end result is my left atrium has large amounts of tissue that are isolated and can't contribute to pumping, which is reflected as small P waves. So even if I still had a fully functional LAA, I'd probably still have small P waves.

To address Cirenepurzalot's concerns, the average person with paroxysmal afib going into their first ablation really doesn't need to worry about reduced left atrial function or having their LAA isolated. Neither is a likely result from one or two ablations by a competent operator. Now, if you have persistent afib that's a different story. Persistent afib very commonly requires isolation of the LAA.

Thanks a lot! I appreciate your response.

Does having a PV ablation increase the risk of needing a LAA isolation?

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Does having a PV ablation increase the risk of needing a LAA isolation?

As far as I know, not at all. It is progression of the illness that will involve more areas "misbehaving" and one of those areas is the LAA.

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cirenepurzalot
Does having a PV ablation increase the risk of needing a LAA isolation?

No, it doesn’t.

Most EPs you will encounter only do PV ablation. In fact, a lot of them will tell you that LAA isolation doesn’t even work. There are only a few operators who practice that. If you go in for a PVI, then a PVI is what you’re going to get.

Thanks everyone for answering my questions.

I had an ablation a year ago from Dr Natale and am very pleased with the result so far. I was in permanent Afib for around a year before the ablation. According to my report, Dr Natale isolated my LAA at the same time he did the ablation (he knows how to do two things at once). I have been Afib free most of the time.

However, there have been 4 instances of SVT or Atrial Flutter (not sure which) since my ablation and most were cleared up with an extra dose of Metoprolol. During the worst instance I went to the ER and was given a cardioversion and immediately went into NSR and have been that way for over 2 months following the cardioversion.

One of my questions for my doctors is will I need to stay on Metoprolol and Eliquis and I know they will tell me. My recent Echo showed an Ejection Fraction of 63%.

I noticed in this thread that ablations can stop the P wave from showing on an ECG, which in turn may require a Watchman and possibly continued Eliquis. See my attached single lead ECG from yesterday where I tried to simulate Lead II (and show the P wave) by taking a measurement near my left ankle. Do you see a P wave? Will I need a Watchman?

Is there anything else I should be asking my doctors?

Thanks,

I definitely see P waves.

But P waves being present or not aren't the justification for a Watchman. If you're in the US it will mainly depend on whether you can tolerate anticoagulants. If you can and you haven't had any major bleeding problems, it's unlikely a Watchman would be covered.

Thanks, Carey.

What else will the doctors need to know to determine if I can stop Metoprolol and Eliquis?

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JakeL
What else will the doctors need to know to determine if I can stop Metoprolol and Eliquis?

Stopping the metoprolol is up to you. You can stop it any time you want and only take it when you go into tachycardia (>100 bpm heart rate). If you find that you go into tachycardia more without it, then use your judgement about taking it daily. You shouldn't allow yourself to be in tachycardia frequently or for long periods of time.

The Eliquis is a much more complex question. You say Natale isolated your LAA. So did you do a TEE six months later? What did Natale have to say about that TEE? If you didn't do a TEE, then absolutely do not stop the Eliquis until you consult with Natale. In fact, don't even miss a single dose or stop it temporarily for colonoscopies, etc.