Honest CHA₂DS₂-VASc scores and need for a DOAC

When I go to do CHA₂DS₂-VASc I have to +1 for 'diabetes history' but if I am no longer a diabetic and blood glucose and insulin are low due to diet why should I mark that as a factor?

Same thing for hypertension. If it's controlled by diet and lifestyle - why mark it?

Secondly, if I am in NSR and have been for several years other than one occasion which I noticed right away, why do I need to take a DOAC on a continual basis or at all?

It's arguable that I am either a 1 or 2 for CHA₂DS₂-VASc at this time.

Right now, I have great insurance that provides me with 2 Eliquis a day which I have been hoarding in case things head south. For much of 2022 I didn't take any but lately have been taking 1 every night as an insurance policy. More than likely I will always have good insurance and will always have affordable Eliquis or affordable Eliquis in 2026 if the pharma crooks don't regame the system. [www.buzzrx.com]

I'm also doing therapeutic phlebotomy and blood donations to keep my HCT in the 42 to 44 range where in the past it was as high as 54. In those days I also had high BP and BG but thankfully no strokes.

BP is also in normal range 125/83 on avg.

Strokes are horrible things but why should I take a DOAC if I am in NSR and have control of BP and BG?

I agree you probably don't need to be on an anticoagulant but I bet you'd get a mix of opinions if you asked several doctors. You could always do what I did: compromise and switch to a half-dose of Eliquis. Doing that got the endorsement of my PCP and two EPs, one of which was Natale. And I have a Watchman which puts me at the same risk level as someone who's never had afib.

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Carey
I agree you probably don't need to be on an anticoagulant but I bet you'd get a mix of opinions if you asked several doctors. You could always do what I did: compromise and switch to a half-dose of Eliquis. Doing that got the endorsement of my PCP and two EPs, one of which was Natale. And I have a Watchman which puts me at the same risk level as someone who's never had afib.

What are the long term side effects of taking Eliquis or other DOAC?

MDs will likely be CYA when it comes to these things.

Based on the half-life I think I might cut these 5mgs in half and take BID.

TY Carey.

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colindo
What are the long term side effects of taking Eliquis or other DOAC?

None are known.

Pradaxa (dabigatran) was approved in the EU in 2008 and Eliquis (apixaban) in 2011. Approval followed a year or so later in the US for both. Neither drug has shown any long-term side effects. And it would be very unusual for a widely-used drug to go 10-15 years without long-term side effects at least beginning to reveal themselves. Long-term side effects are usually an accumulations of "small" injuries that go undetected for years. That means that some "fragile" patients will be more sensitive to those injuries than others and show them sooner, so those patients are the canaries in the mine. So far, the canaries are perfectly fine after 15 years of Pradaxa and 12 years of Eliquis.

Eliquis side effects include doubt and curiosity and also the strong need for forum posting.

Oh good, first drug without any side effects

Eliquis doesn’t affect me. It maybe the first drug. Lisinopril gave me the coughing side effect, BB gave me ezcema. Crestor gave me muscle cramps, multaq horrible GERD, flecainide gave me insomnia... but Eliquis no problems but some bruises. It’s better to be protected than risk a stroke.

As a newbie to this forum I find it difficult to follow when so many acronyms are used and no place to see them defined. I understand the need to use them but I find this unknown makes it difficult to fully understand the communication.

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melturet
As a newbie to this forum I find it difficult to follow when so many acronyms are used and no place to see them defined. I understand the need to use them but I find this unknown makes it difficult to fully understand the communication.

Yes I agree. In the past I asked for a place where these abbreviations could be defined and so far no luck.

BTW what does CYA mean?

AF- atrial fibrillation
ECV- cardioversion using paddles and joules of electricity
BB is beta blocker drug to lower one’s HR (heart rate).
NSR- normal sinus rhythm
DOAC- Direct oral anticoagulants (DOACs)—dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa), and betrixaban (Bevyxxa) are anticoagulation pharmacotherapy used for the prevention of thrombosis in several cardiovascular contexts.

Any acronyms in particular?

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colindo
BTW what does CYA mean?

My favorite, this should help:
[www.aafp.org]

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colindo
BTW what does CYA mean?

It's an American expression. It means "cover your ass." If you say "doctors are answering with CYA" you're saying their answers are just safe for them and not necessarily the truth.

BP blood pressure
BG blood glucose
HCT hematocrit

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susan.d
Eliquis doesn’t affect me. It maybe the first drug. Lisinopril gave me the coughing side effect, BB gave me ezcema. Crestor gave me muscle cramps, multaq horrible GERD, flecainide gave me insomnia... but Eliquis no problems but some bruises. It’s better to be protected than risk a stroke.

Good to know Susan! My post is a bit of smart A but not entirely. A friend was on Warfarin for a few years with quit unpleasant side effects. When NOAC became available he was put on Pradaxa. Initially (few months/a year - forgot exact time) he thought it was the best since sliced bread. But after his 'honeymoon' he got bad side effects to the extent that he thought about joining a class action that was supposed to be happening in Europe

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Joe
Oh good, first drug without any side effects

Nobody said that. We all know all drugs have side effects. The question was long-term side effects, side effects that don't become apparent for years.

Surely we could place a sticky post at the top of this forum, and it ought to be a mini-glossary and list of common initialisms (acronyms are sounded, like LASER and RADAR. Otherwise, abbreviations are merely initialisms, such as PVC, AF, and eg).

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gloaming
Surely we could place a sticky post at the top of this forum, and it ought to be a mini-glossary and list of common initialisms (acronyms are sounded, like LASER and RADAR. Otherwise, abbreviations are merely initialisms, such as PVC, AF, and eg).

Sure, we can do that. I wouldn't bother distinguishing between different types of abbreviations, but a simple list of commonly used abbreviations here would be helpful to many people.

So I'll start one. Here's the way it will work. I'll begin a list just to establish a format and pin it. Anyone can make a post to add an entry. If no one objects to the addition, I'll edit the original post to include it, and then delete the post so all we ever have for long is the original pinned post.

Thanks, Carey. I often struggle with a lot of those acronyms. As I'm French speaking, many of them are in reversed orther compared to those in my common language. Some are different too.

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Carey
And I have a Watchman which puts me at the same risk level as someone who's never had afib.

I'd like to know where you get that information. A watchman is supposedly, at best, as effective as a DOAC at preventing stroke. A DOAC reduces one's risk by 60-70%. So, if an AFib sufferer has 5-8X the risk of stoke of someone whose never had AFib, how can reducing that risk by 60-70% bring the risk to that of a person who never had Afib?



Edited 1 time(s). Last edit at 02/14/2023 12:55AM by jasams.

There's kind of an apples and oranges problem here. Those numbers are all from clinical trials where the numbers are gathered and calculated very differently from real life.

The clots responsible for 90% of all afib-related strokes originate in the left atrial appendage (LAA). With a Watchman, the LAA is completely isolated from the circulation and therefore can't release clots at all. That's a de facto 90% reduction.

See my post about the CHAMPION-AF trial that will compare effectiveness of Watchman and DOACs

There is a NIH study underway that will determine if the Watchman is a reasonable alternative to NOACs. It is scheduled to be completed in December 2027.

CHAMPION-AF Clinical Trial - NIH US National Library of Medicine

Study Description, Brief Summary:

The primary objective of this study is to determine if left atrial appendage closure (LAAC) with the WATCHMAN FLX device is a reasonable alternative to non-vitamin K oral anticoagulants (NOACs - Xarelto, Pradaxa, Eliquis, Lixiana) in patients with non-valvular atrial fibrillation.

Actual Study Start Date : October 15, 2020
Estimated Primary Completion Date : December 2025
Estimated Study Completion Date : December 2027

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Carey

What are the long term side effects of taking Eliquis or other DOAC?

None are known.

One side effect of any DOAC is a brain hemorrhage -- leading to severe disability or death. The longer one stays on a DOAC, the more likely this side effect will happen. Carey, you are convinced that your watchman obviates your need for any anticoagulant, yet you still take one. Of course, that is your choice, but, if as you believe, your watchman results in your risk of stroke being the same as someone who never had AFib, then I would surmise that you should logically believe that everyone (including non-AFibbers) should be taking a DOAC. I doubt you'll find much, if any, support for that. Not trying to be argumentative, but I think many people downplay the risk of these medications and downplaying the risk of these drugs is not serving the interest of the AFib community. I would do almost anything to get off an anticoagulant, at least the current generation of these drugs.



Edited 1 time(s). Last edit at 02/22/2023 04:29PM by jasams.

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jasams
One side effect of any DOAC is a brain hemorrhage -- leading to severe disability or death. The longer one stays on a DOAC, the more likely this side effect will happen. Carey, you are convinced that your watchman obviates your need for any anticoagulant, yet you still take one. Of course, that is your choice, but, if as you believe, your watchman results in your risk of stroke being the same as someone who never had AFib, then I would surmise that you should logically believe that everyone (including non-AFibbers) should be taking a DOAC.

A few thoughts....

DOACs do not cause hemorrhagic strokes, or bleeding anywhere else for that matter. Anticoagulants will prolong bleeding, but they don't cause it. That's a subtle but important distinction. So they can turn a minor, perhaps even undetectable bleed into a dangerous bleed, but they can't be said to be the cause.

No, I don't think my Watchman entirely obviates my need for an anticoagulant. There's still that 10% of afib-related strokes that don't begin in the LAA, and there are still strokes that originate outside the atria, and outside the heart entirely. A Watchman does absolutely nothing for those. That's why I chose to continue half-dose Eliquis. It's safer and more effective than aspirin, and it will cover me against almost all sources of embolic stroke.

The question of DOACs for people who don't have afib is actually a legitimate and interesting one. Although the CHADS score was devised for people with afib, it's still a valid predictor of stroke risk in people who don't have afib. If I had a very high CHADS-Vasc score but had never had afib, I might indeed ask my doctor for a prescription. I believe such prescribing does happen more often than we know. After all, there are people out there without afib who have a very high embolic stroke risk, so why would a doctor not consider it?

I don't think anyone's downplaying the risks of DOACs, they're just following the data. The risks of anticoagulants are well known and quantified, and the numbers come down resoundingly in their favor. The current generation of DOACs are remarkably safer than warfarin and aspirin, serious side effects are rare, and the stroke prevention they offer greatly outweighs the risks of those complications.

One thing I've noticed with people here and elsewhere is that anticoagulants scare people far beyond reality. They scare people far more than the antiarrhythmics, and if there's a type of drug that should scare people it's them, not DOACs.

May I ask what it is about the current generation of DOACs that you fear/dislike so much?

Well explained Carey, been on Xarelto for almost 10 years with absolutely no bleeds, bruising, healing issues or stroke that I know of.
I had acute appendicitis and a subsequent appendectomy 2 years ago which made this difficult being on Xarelto, my surgeon wanted me to hold it back for 3 days after surgery but I basically refused and told him I needed to start it after 36 hours.
After a 2 week post op visit, he was amazed how well my incisions healed, it was Laparoscopic but regardless I heal well.

As you know I have a date with Natale this week for a watchman and touch-up ablation that would allow me to to suspend
my NOAC for a biopsy. I fully expect to stay on a low dose even with the Watchman, having prior TIA's was no fun.


McHale