coumadin / xeralto/ eliquis

I know the last two are preferable for afib. Mom has some sort of leaky valve situation (TBD.. I can't get much info out of them because they are old and don't ask the questions they don't know to ask). but Doc putting mom on coumadin. Can the others be used for leaky valves? Or is coumadin preferable? Mom was suppose to eat low sodium and wondered if potatoes had low sodium (yes mom). and Do pot pies have salt? So that is her knowledge on foods and such. She and dad enjoy smoothies every afternoon (my dad's hemoglobin was 4 this summer). To their credit they did change up to include more greens (and meats) when that happened. They are 80. Anyway thanks for listening to all this. Really just want blood thinner question. many thanks.

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bettylou4488
Mom has some sort of leaky valve situation (TBD

So, you are not sure what is going on there? They say Eliquis should not be used in patients whose Afib comes from valve disease, but when you drill it down, it seems to mean having a prosthetic valve. I had a leaky mitral valve (now repaired but not with a prosthetic valve) and I have always been prescribed Eliquis.

The DOAC manufacturers didn't pursue approval for valve disease patients, so the result is the data on DOACs with valve disease is still pretty limited. There have been one or two studies, and those showed that apixaban and warfarin provide comparable protection, but most doctors wouldn't feel comfortable prescribing apixaban. They'd be standing on a thin branch if anything didn't go well, so they stick to warfarin for valve patients.

A shame, really, since the elderly would benefit the most from getting off warfarin and onto a DOAC since the bleed risks are lower.

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Carey
The DOAC manufacturers didn't pursue approval for valve disease patients, so the result is the data on DOACs with valve disease is still pretty limited. There have been one or two studies, and those showed that apixaban and warfarin provide comparable protection, but most doctors wouldn't feel comfortable prescribing apixaban. They'd be standing on a thin branch if anything didn't go well, so they stick to warfarin for valve patients.

A shame, really, since the elderly would benefit the most from getting off warfarin and onto a DOAC since the bleed risks are lower.

Well that is surely disappointing! I did find one study on Xeralto vs. warfarin. I am thinking they do this out patient now- with daily trips into the blood draw place. I was hoping for a different answer. . Thanks for responding though!

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Carey
The DOAC manufacturers didn't pursue approval for valve disease patients, so the result is the data on DOACs with valve disease is still pretty limited. There have been one or two studies, and those showed that apixaban and warfarin provide comparable protection, but most doctors wouldn't feel comfortable prescribing apixaban. They'd be standing on a thin branch if anything didn't go well, so they stick to warfarin for valve patients.

A shame, really, since the elderly would benefit the most from getting off warfarin and onto a DOAC since the bleed risks are lower.

Yet, three cardiologists (including Dr. Natale) have prescribed Eliquis for me.

You'd think that with as much money as they make off of DOACs pharma could run a trial for these people but guessing they looked at the numbers and there's not enough profit in it. Or they already know it's a bad idea.

It's probably that the valve disease market isn't big enough to justify the cost of the clinical trials they'd have to do to get regulatory approval. And they know that doctors will gradually begin prescribing them off-label anyway, like Daisy mentioned above.

There are a whole lot of drugs being used off-label for afib. Even flecainide isn't approved to treat afib, or any atrial arrhythmia. I'd have to check but I bet that's true of most of the antiarrhythmics.

Finally talked to the nurse. The issue is a mass on my mom's heart.. Two of them. so doing an MRI to find out what but they put her on coumadin until the MRI in case they are blood clots. or whatever a heart mass is?? They thought I had a blood clot once from a TEE and turned out on the CT to be nada. The nurse did say she could switch to Eliquis but I said- leave it alone for now...