Choosing NOAC Half Dosing

Several long time ex-Afibbers here have chosen to continue half doses of various blood thinners, 2.5 mg Eliauis twice daily being the most mentioned.

Obviously a prescription is needed to source the pills so some physicians support this practice.

I have asked the NP who works with Dr. Natale where I had my ablation 16 months ago for Dr. Natale's current opinion but have received no response.

For a brief history, My first Natale ablation was in 2007 after what was then called lone afib and flutter. The afib came back in 2018 and I had a second Natale ablation in 2020 when he also ablated my LAA. My 6 month TEE was tight enough that I didn't need a Watchman, further NOAC's or an aspirin and I am still in NSR today. However, I am 85 years old and in otherwise good health with retular exercise of tai chi and farming. I do, however, take a baby aspirin upon recommendation of my Cardiologist who says there are a lot more people in his hospital with strokes caused by blood clots than by excessive bleeding. He thinks the one size fits all NOAC's are binary, either they work as prescribed or they don't work at all. I had no significant bleeding issues when on full dose Eliquis, a walk in the park compared to the Warfarin I had to take in the early 2000's.

Certainly my CHADS score alone would have me still on the medication. I'm trying to decide what would be best for me.

Does anyone know of actual published studies about the risk/benefits of half dosing NOAC's for ex-afibbers? I can't seems to find any.

I don't know of any studies looking at exactly that, but there are studies showing that Eliquis is superior to aspirin and has a lower bleed risk. That's why I chose to remain on half-dose Eliquis rather than taking a low-dose aspirin as Natale, my PCP, and my local EP all think I should. I'm pretty confident Natale would say the same to you, so I would try to contact his NP again. If you can't reach them, you could also take the question to your cardiologist. If he's at all up to date on his continuing education on the subject he knows Eliquis is a safer, more effective choice (albeit much more expensive).

Here's one study from 2015, AVERROES. that seems to confirm your action, however the dosages seem to be pretty all wide for both Eliquis and Aspirin:

[pubmed.ncbi.nlm.nih.gov]

They comment on VKA, (warfarin), treatment as being unsuitable for patients in their trial.

They give the 2.5 mg Eliquis twice daily to selected patients and everyone else the 5 mg twice daily compared to different aspirin dosages.

I'm sure both Natale and my Cardiologist are aware of this and other related studies mentioned but I'll send the reference off to Natale's NP and my doc for hopeful thoughtful replies.