Stopping Eliquis

My local paper had the story that stopping Eliquis suddenly causes a rise in clot events, according to some study. Says it should be tapered off. This caught my eye because I have simply stopped the Eliquis when medical procedures have required it. Is this something I need to pay attention to now?

I recall a study that had results like that, but it was several years ago and as I recall the study was very small and rather flawed. People stop Eliquis (and the other DOACs) all the time without tapering. The local paper isn't a good source of medical information but I'd have to see the article to comment on it directly.

I suppose there could be some kind of rebound effect theoretically, but I doubt it. People who stop statins don't seem to get a rebound of extra LDL production. People who stop Cymbalta don't go into horrible and worse depressions or anxiety than previously. I am going to suspect that the writer, probably not with a STEM background, read more into the results than the authors intended. Of course more clots are likely, but not more clots than might have been the risk prior to taking apixaban or something else in the first place.

The mention was in a newspaper column from the syndicated People's Pharmacy. The writers cite a study in the November 27, 2023, edition of the Pharmacoepidemiology & Drug Safety journal where they say that people are more prone to dangerous blood clots shortly after stopping Eliquis. Of course, I have no ability to judge the adequacy of the study even should I find it to read!

I dug up the study and found that it had (in my reading) nothing to do with tapering or not tapering discontinuation of DOAC. The article in "People's Pharmacy" talked about tapering; however, the study they cited appeared to indicate that there was an increased stroke use following discontinuation of the DOAC and there was a time-dependence of stroke frequency. (More likely to occur 1 - 6 months after discontinuation than either prior to 1 month or subsequent to 6 months; highest risk in the 2 - 3 month range).

I didn't read either publication rigorously and would expect that I've missed some nuances; however, I'd agree that the local paper may have sensationalized the news.

Thank you so much for this.

There was a thread on this topic about 4-5 years ago on this site. There is a warning about this on the patient package insert that comes with Eliquis [packageinserts.bms.com].

I think this is in part driven by liability concerns. After doing some research and talking with my Dr. (5 years ago), I came to the conclusion that the decision to get off anti-coagulants trumps this warning, meaning that if you make the decision to get off, it's not worth not getting off the drug, otherwise you would be stuck on it forever.

Here is the full study [onlinelibrary.wiley.com] One thing I always look for in study results are confidence intervals (CI) for odss ratios that go above and below 1.0 (example 0.35 - 1.45). This means that result is not statistically significant. Many of the CIs include 1.0.



Edited 1 time(s). Last edit at 01/18/2024 07:41AM by GeorgeN.

Folks need to be aware that the statement about CI extending below and above 1.0 only means the result is not statistically significant when the discussion is about something like "odds ratio" as it is in the study under discussion. (Thanks for posting the link, George). CI can be used in various ways.

Quote
mike111
Folks need to be aware that the statement about CI extending below and above 1.0 only means the result is not statistically significant when the discussion is about something like "odds ratio" as it is in the study under discussion. (Thanks for posting the link, George). CI can be used in various ways.

Correct & I edited my post.

I found this article today on People's Pharmacy, which has good information.

I think the studies are indicated. Also, the issue is for aspirin.


Can Stopping Aspirin or Eliquis Suddenly Lead to Deadly Blood Clots?

I spoke to Dr. Natale's office today, and their feedback is that they look at each patient holistically, weighing their stroke risk, before stopping Eliquis, including the CHAD score. They don't stop Eliquis immediately after an ablation, either.

I had a call with a pharmacological geneticist today who explained their protocol for weaning off Eliquis. They believe weaning off Eliquis can be a good idea in certain cases. Best to discuss with your doctor of course.