Deciding to take Eliquis with infrequent Afib

Re: Deciding to take Eliquis with infrequent Afib

colindo — Fri, 28 Sep 2018 17:25:02 +0000

I could be mistaken as I can't find the article.

Re: Deciding to take Eliquis with infrequent Afib

hwkmn05 — Fri, 28 Sep 2018 10:29:03 +0000

Gill-I do take fish oil and nattokinase, I take magnesium, potassium, taurine and d-Ribose. I exercise three times a week.

Like the regimen and love the attitude! Except for the Pot supplement. It has thrown me out of NSR twice and not a supp I care for.

I have read certain studies from the UK which report, Mortality from stroke was highest in those with the lowest vitamin C status.
My daily intake is around 5-6 gms for 5 years now with no issues.

Re: Deciding to take Eliquis with infrequent Afib

jpeters — Fri, 28 Sep 2018 05:57:03 +0000

Quote
Carey
. Warfarin eating away at the arteries is particularly the thing I wanted to hear about. I don't believe that's true.

"How much warfarin will kill a rat?
Mice and rats like the taste of the bait, while the warfarin prevents their blood from clotting which will kill the rodents within a few days because of bleeding into their brain. The safety of warfarin was not determined in humans until a farm worker attempted to commit suicide by eating the rat poison" :)

[www.setma.com]

Re: Deciding to take Eliquis with infrequent Afib

Carey — Fri, 28 Sep 2018 04:21:50 +0000

The first paragraph of the abcnews story pretty much sums it up. As I said, anticoagulants prolong bleeding caused by other things. They don't cause bleeding. Warfarin eating away at the arteries is particularly the thing I wanted to hear about. I don't believe that's true.

Re: Deciding to take Eliquis with infrequent Afib

colindo — Thu, 27 Sep 2018 22:25:14 +0000

Warfarin-induced gastric bleeding

[www.ncbi.nlm.nih.gov]

also

[abcnews.go.com]

Re: Deciding to take Eliquis with infrequent Afib

Carey — Thu, 27 Sep 2018 14:16:28 +0000

Quote
colindo
Warfarin will cause bleeding, it eats away at the arteries, that's how it kills rats.

Never heard that one. Got something to back that up?

Re: Deciding to take Eliquis with infrequent Afib

colindo — Thu, 27 Sep 2018 09:55:22 +0000

Warfarin will cause bleeding, it eats away at the arteries, that's how it kills rats.

Re: Deciding to take Eliquis with infrequent Afib

Carey — Thu, 27 Sep 2018 01:24:14 +0000

Quote
Elizabeth
So why does stopping an anticoagulant causes bleeding to cease?

Because the anticoagulant effects wear off and your blood coagulates again.

Re: Deciding to take Eliquis with infrequent Afib

Elizabeth — Thu, 27 Sep 2018 00:43:17 +0000

So why does stopping an anticoagulant causes bleeding to cease? Oh well, believe what you want and so will I.

Re: Deciding to take Eliquis with infrequent Afib

Carey — Wed, 26 Sep 2018 23:30:09 +0000

Quote
Elizabeth
Carey says anticoagulants don't cause bleeding?

They don't. The only prolong bleeding caused by other things.

Re: Deciding to take Eliquis with infrequent Afib

wolfpack — Wed, 26 Sep 2018 20:00:13 +0000

Quote
colindo
That is the question, what causes the risk to rise as we age?
Is it the junk that flows around in our blood caused by the increase in fibrinogen etc.?
If so then natto can clean most that up, and lower fibrinogen levels.

Blood clots when the flow gets turbulent. Smooth endothelia (inside walls of ateries) promote smooth, laminar flow. As we age, those inner walls get "stuff" stuck on them (plaque), and they also get less "stretchy" so the pressure goes up and the flow becomes more turbulent. This is why your cardiologist likes to listen to your carotids when he or she examines you. He's listening for something called bruit (brew-wee) and it is the sound of turbulent blood flow, and its easiest to hear in that location given the arteries' close proximity to the surface of the skin.

Re: Deciding to take Eliquis with infrequent Afib

Elizabeth — Wed, 26 Sep 2018 18:35:26 +0000

In the article that George has given a link to has this about anticoagulants:

The trials involving dabigatran and apixaban were stopped early
because of increased bleeding rates.

Carey says anticoagulants don't cause bleeding?

Re: Deciding to take Eliquis with infrequent Afib

GeorgeN — Wed, 26 Sep 2018 14:15:12 +0000

Here is a paper Prediction of stroke or TIA in patients without atrial fibrillation using CHADS2 and CHA2DS2-VASc scores
<[pdfs.semanticscholar.org]

Stroke, TIA & death risk do increase materially in non-afibbers.

I think there is a calculator where you can predict stroke risk by age with or without afib, including CHADs or whatever risks. There are also papers showing the impact of OAC (risk reduction). Doing this for yourself would give you an idea of your risk and risk reduction by taking OAC's. That is the way to make an informed decision.

Separately:

Quote
Carey
Oh, and your dedication to managing your afib with near-superhuman efforts is impressive, but I don't think you've defeated the aging thing. So saying it's not true for all isn't quite right. You've delayed it or slowed it, probably significantly, but nobody can eliminate it.

I'm well aware that I'm aging. My objective is to have my health span and life span coincide as closely as possible. Also to be able to continue to follow my active passions. I look at not having metabolic issues as foundational. While detraining from endurance exercise is part of my "system," maintaining a very high level of fitness using other modalities is also very important.

Re: Deciding to take Eliquis with infrequent Afib

Brian_og — Wed, 26 Sep 2018 08:12:09 +0000

Quote
Carey

that gives you a 1.7% risk of stroke

To be clear, that gives her a 1.7% annual risk of stroke, which doesn't sound so bad, but people need to understand that annual risks are cumulative. A 1.7% annual risk translates to a 15.7% risk of stroke over 10 years, or 29% over 20 years. It's a non-trivial level of risk.

I didn't want my original point/question to get lost here but according to the ATRIA scoring system Karin's 1.7% chance of stroke would place her between 0 and 1 on the CHADS VASc scoring system, rather than the 2 she's now getting. That's the difference between don't worry about AC and definitely use AC.

Another article re ATRIA

[www.the-hospitalist.org]

"Bottom line: The ATRIA risk score better identifies Afib patients who are at low risk for stroke compared to CHADS2 and CHA2DS2-VASc scores."

Re: Deciding to take Eliquis with infrequent Afib

Brian_og — Wed, 26 Sep 2018 08:01:29 +0000

Quote
Carey

Does anyone know anyone that recommends just stopping AC after a successful Ablation? Depending on how we define successful also I guess.

Sure, Natale will for some patients. So will my local EP. A lot of EPs will advise patients to stop anticoagulants following a successful ablation, but it depends on their CHADS-Vasc score and the EP's assessment of their stroke risk from other aspects. But there is no standard formula for who can stop and who can't. It's very patient specific.

But that confuses me too. If the ablation is successful then why bother looking at the CHADS VASc score at all. They don't give AC to non afibbers with scores above 1 or 2 or even more as far as I know. The only way this makes sense to me is if they are never sure that an ablation has been really "successful". Is that the case?

Re: Deciding to take Eliquis with infrequent Afib

jpeters — Wed, 26 Sep 2018 05:39:17 +0000

Quote
Carey

Similar analogies abound. The odds of you being in a car crash is the same for every mile you drive, but driving 100 miles obviously puts you at greater risk of an accident than driving one mile. That's exactly the same math at work.

Good drivers acquire experience, so can actually lower their risk. When experience won't help, say playing a slot machine, a lot of data points eventually approaches the true odds against you. In the beginning, however, it's pure chance, so winning or losing streaks are not uncommon.

Re: Deciding to take Eliquis with infrequent Afib

colindo — Wed, 26 Sep 2018 04:13:15 +0000

Quote
Carey

Good point about risk rising as we age.

That is the question, what causes the risk to rise as we age?
Is it the junk that flows around in our blood caused by the increase in fibrinogen etc.?
If so then natto can clean most that up, and lower fibrinogen levels.

Re: Deciding to take Eliquis with infrequent Afib

Joe — Tue, 25 Sep 2018 23:47:05 +0000

Quote
Brian_og
In one of the studies mentioned in the John Day article above it states the following:

"Atrial fibrillation (AF) is a commonly encountered arrhythmia, which is not yet fully understood. Catheter ablation has shown to be an effective strategy for rhythm management and several small or retrospective studies have shown that stroke rates are decreased in ablated AF patients compared to those medically managed. Several studies even show that ablation returns stroke risk to that of non-AF patients. Large scale, prospective trials will further illuminate this connection and provide mechanistic understanding of the role of the procedure versus the process of selection for the procedure and peri- and post-procedural therapy and management. Furthermore, modification of risk factors associated with AF show a significant increase in the sustained success of AF ablation and can also moderate the progression of AF."

Does anyone know anyone that recommends just stopping AC after a successful Ablation? Depending on how we define successful also I guess.

I suspect John Day is onto something (or my wishful thinking?)
My Cardiologist recommended against my stopping AC a year ago but i did anyway as i was not in afib for about one year.
Last week i got the AF back (HR90 - 130) and began taking Eliqus and Sotalol after 2/3 hours or so again.
Still taking it after 9 days even though my HR is in the 50s/60s and sometimes up to 90s/110s for short instances but predominately in the lower ranges.

Chads etc scores are valuable but i think George is onto something with diet and life style.
Can't see any reason for stroke risk to increase in non AF people with risk factors as low as George mentions. Perhaps LAA appendage shape and ejection fraction of it and generally come into it as well? Ah, and a coronary calcium score of zero would help? Mine is 36 so i don't know what to think re AC for me :(

BTW, love your attitude Gill! (post 373) Hope i get there some day :)

Re: Deciding to take Eliquis with infrequent Afib

Carey — Tue, 25 Sep 2018 23:45:54 +0000

Quote
GeorgeN
Not per Carey's example, but stroke risk in general increases as we age, afibber or not. Just like blood pressure and heart disease risk. However, this is not true for all, and is likely lifestyle related. For example at 63, I strive to keep my BP at 105/65 without meds. I also strive to keep my blood sugar low with fasting around 4.1 mmol/L in your units (75 mg/dL for the US), and so on for all the metabolic markers. From my reading there is a correlation of blood viscosity with these other metrics.

Good point about risk rising as we age, but I didn't want to muddy the waters with that since the change from one year to the next is barely measurable. You get one more CHADS point at 65, but I'm pretty sure that on the morning of your 65th birthday nothing significant happens to your stroke risk.

Oh, and your dedication to managing your afib with near-superhuman efforts is impressive, but I don't think you've defeated the aging thing. So saying it's not true for all isn't quite right. You've delayed it or slowed it, probably significantly, but nobody can eliminate it.

Re: Deciding to take Eliquis with infrequent Afib

GeorgeN — Tue, 25 Sep 2018 23:17:27 +0000

Quote
colindo
The question is, WHY does the stroke risk increase each year? What is the cause?
It doesn't make any sense that your risk factor can be 1.7 and the nest year it's approx double.
WHY? What is the cause?

Not per Carey's example, but stroke risk in general increases as we age, afibber or not. Just like blood pressure and heart disease risk. However, this is not true for all, and is likely lifestyle related. For example at 63, I strive to keep my BP at 105/65 without meds. I also strive to keep my blood sugar low with fasting around 4.1 mmol/L in your units (75 mg/dL for the US), and so on for all the metabolic markers. From my reading there is a correlation of blood viscosity with these other metrics.

George

Re: Deciding to take Eliquis with infrequent Afib

Carey — Tue, 25 Sep 2018 22:26:40 +0000

Quote
mwcf
Noted Carey and thanks as always for your input, but at Bordeaux the protocol is AC for 3 months after ablation for all patients including paroxysmal AFrs and regardless of CHADS-Vasc score.

Yes, sorry for not being clear. I wasn't counting the blanking period. All EPs will insist on ACs for at least 90 days following an ablation. And that's way to soon to declare success anyway. Six months would be the minimum, and true success is defined as no atrial tachycardias after the blanking period for one year without the need for antiarrhythmic drugs.

Re: Deciding to take Eliquis with infrequent Afib

mwcf — Tue, 25 Sep 2018 20:23:43 +0000

Quote
Carey

Does anyone know anyone that recommends just stopping AC after a successful Ablation? Depending on how we define successful also I guess.

Sure, Natale will for some patients. So will my local EP. A lot of EPs will advise patients to stop anticoagulants following a successful ablation, but it depends on their CHADS-Vasc score and the EP's assessment of their stroke risk from other aspects. But there is no standard formula for who can stop and who can't. It's very patient specific.

Noted Carey and thanks as always for your input, but at Bordeaux the protocol is AC for 3 months after ablation for all patients including paroxysmal AFrs and regardless of CHADS-Vasc score. Likely in case of possible blanking period arrhythmia episodes plus I’m sure I’ve read before that ablation-related embolisms can occur as much as 90 days after an ablation. And see for example.....

[www.medscape.com]

Re: Deciding to take Eliquis with infrequent Afib

Carey — Tue, 25 Sep 2018 20:11:57 +0000

Quote
Brian_og
Does anyone know anyone that recommends just stopping AC after a successful Ablation? Depending on how we define successful also I guess.

Sure, Natale will for some patients. So will my local EP. A lot of EPs will advise patients to stop anticoagulants following a successful ablation, but it depends on their CHADS-Vasc score and the EP's assessment of their stroke risk from other aspects. But there is no standard formula for who can stop and who can't. It's very patient specific.

Re: Deciding to take Eliquis with infrequent Afib

Carey — Tue, 25 Sep 2018 20:07:34 +0000

Quote
colindo
The question is, WHY does the stroke risk increase each year? What is the cause?
It doesn't make any sense that your risk factor can be 1.7 and the nest year it's approx double.
WHY? What is the cause?

It does not increase each year. Your risk of having a stroke in 2018 is exactly the same as your risk of having a stroke in 2019, 2020, and so on (until your CHADS-Vasc score changes).

What I was trying to explain is that risk is cumulative. It's exactly like rolling dice. Your odds of rolling a particular number is exactly 1-in-6 every time you roll a single die. No matter how many times you roll, your odds of rolling that number are the same each time. However, the more times you roll, the more likely it is that you'll eventually roll that number. Makes sense, right? The more tries you make, the more likely it is you'll eventually roll the number you're looking for. The same thing happens with stroke risk. Think of living for a year as being like rolling the dice one time. If you roll the dice once a year, every year for 10 years, the odds that a stroke will happen at least once will go up by the formula I explained earlier.

Similar analogies abound. The odds of you being in a car crash is the same for every mile you drive, but driving 100 miles obviously puts you at greater risk of an accident than driving one mile. That's exactly the same math at work.

Re: Deciding to take Eliquis with infrequent Afib

colindo — Tue, 25 Sep 2018 18:34:38 +0000

The question is, WHY does the stroke risk increase each year? What is the cause?
It doesn't make any sense that your risk factor can be 1.7 and the nest year it's approx double.
WHY? What is the cause?

Re: Deciding to take Eliquis with infrequent Afib

Pompon — Tue, 25 Sep 2018 17:23:06 +0000

Quote
karin
QUESTION? Have you all noticed if there are a lot of people complaining of serious side effects of Eliquis (e.g., nausea, joint pain, fatigue) as I have read on this forum?

It seems that Eliquis is the most prescribed NOAC for people on this forum, so you'll read more about it.
Here in Belgium, it seems Xarelto and Pradaxa are more often prescribed than Eliquis.
Having taken successively Pradaxa, Xarelto, Lixiana (= Savaysa) and Pradaxa again, I've noticed I'm doing better with the latter than with Xarelto and Lixiana. I've not tried Eliquis.
I've asked the question to my pharmacist, and she replied it's just a personal thing. She's got good and bad reports for each of those NOACs.

Re: Deciding to take Eliquis with infrequent Afib

jpeters — Tue, 25 Sep 2018 17:14:36 +0000

Quote
Brian_og

Does anyone know anyone that recommends just stopping AC after a successful Ablation? Depending on how we define successful also I guess.

That's the point, but only after the blanking period and only if all arrhythmia is gone.

Re: Deciding to take Eliquis with infrequent Afib

Brian_og — Tue, 25 Sep 2018 17:09:01 +0000

In one of the studies mentioned in the John Day article above it states the following:

"Atrial fibrillation (AF) is a commonly encountered arrhythmia, which is not yet fully understood. Catheter ablation has shown to be an effective strategy for rhythm management and several small or retrospective studies have shown that stroke rates are decreased in ablated AF patients compared to those medically managed. Several studies even show that ablation returns stroke risk to that of non-AF patients. Large scale, prospective trials will further illuminate this connection and provide mechanistic understanding of the role of the procedure versus the process of selection for the procedure and peri- and post-procedural therapy and management. Furthermore, modification of risk factors associated with AF show a significant increase in the sustained success of AF ablation and can also moderate the progression of AF."

Does anyone know anyone that recommends just stopping AC after a successful Ablation? Depending on how we define successful also I guess.

Re: Deciding to take Eliquis with infrequent Afib

Jackie — Tue, 25 Sep 2018 14:21:10 +0000

Just a comment on the overall risk of stroke... which has to do with blood's hypercoagulability property... a topic that has been discussed in various previous posts explaining the science of Hemorheology and the sheer-stress factor that influences clotting tendencies. This equates to thick, sticky blood which then has the tendency to form clots more easily... whether or not you experience AF events. There are natural remedies that help keep blood 'thin and slippery' and there are lab tests that can be done routinely to monitor that so you stay in the safe ranges.

I used these for many years during my afib onset and then eventually, after my initial ablation because warfarin/Coumadin was the only available anticoagulant at the time... and since I have low platelets, it was extremely difficult to maintain the requisite INR.

(Obviously, aspirin is out for me.) From the onset of the initial AF (age 59) to the first ablation, it was 8 years and as is typical, I started with relatively low event recurrence and escalated to many, close together and for long durations...typically 20+ hours. Then I had the Exatest and learned I was low in magnesium and potassium. I had a date for an ablation in 6 months and I decided to do all I could to reverse the event recurrence. After 3 months of intense repletion of electrolytes, I went to zero AF and was on the fence about cancelling the ablation date but as I’ve commented, a change in my insurance was upcoming so I went ahead and kept the date with Dr. Natale.

Once I was free to stop warfarin post-ablation, I went back on the natural protocols including Nattokinase (fibrinolytic enzyme) that kept all my lab ranges in the low risk for hyperviscosity and continued faithfully until 11 years later when I began having flutter episodes which I knew would need to be ablated. I was prescribed Eliquis and remain on half dose.

The side effects of Eliquis are real and undoubtedly affect some individuals, more than others, but since I am typically sensitive to chemicals and drugs, the side effects for me are worsening with time. Since it’s the only medication I take, it’s fairly obvious that’s the culprit.

I agree with Gill’s summary statement. Thanks Gill. I’m so glad you are enjoying life.

Jackie

Re: Deciding to take Eliquis with infrequent Afib

GeorgeN — Tue, 25 Sep 2018 13:17:45 +0000

Quote
jpeters
(People in the control group have more strokes over time as well).

I'm currently in the land of very little and very spotty wifi bandwidth, so looking up studies is difficult Point is that the control group will have a non-zero stroke risk that increases with age. Also, as I recall, warfarin will reduce whatever your statistical stroke risk is in half, the studies of the new AC's compare them to warfarin and they are acceptable if they are "non inferior."

I'm guessing that at some low level of stroke risk the bleeding risk will counter the stroke risk reduction, hence AC's are not prescribed below a certain risk.

As to aspirin, my doc had me on 83 mg/day to enhance the anti inflammatory properties of fish oil. My forearms started looking like someone on warfarin who was above the therapeutic range. Hence I quit the aspirin. I rock climb all the time, so my limbs are normally bruised, scratched and scabby from paying "tithes to the rock god," but this was a lot worse.