A good Blood Thinner

Hi David I have been taking Eloquis for some time now and have experienced no side effects at all. Regarding this drug having no antidote at the moment, I was told that the effects of this drug only last 12hours which is why you take it twice a day. It also means that should a bleed occur it should stop fairly quickly. I think the risk of stroke is so high with AF that blood thinners are necessary. Hope this was helpful, good luck.

Just a quick comment.

All blood thinners are not ther same. When we are talking about our risks we should weight up the evicence very carefully and clearly.

Dabigatran (Pradaxa) was the first drug that was available in the United States.  Dabigatran comes in two doses in the United States, 150 mg twice daily or 75 mg twice daily.  Dabigatran was not only equal to warfarin, but it proved to be superior to it in preventing stroke in the RELY trial (1).  Bleeding rates in the head were lower with dabigatran.  However, bleeding from the stomach or bowels was higher.  The most common side effect was dyspepsia, which is a term used to describe stomach pain.  Dyspepsia was relatively common occurring in approximately 11% of people.  The lower dose available in the United States is for people that have moderate kidney dysfunction.  It is important to know that the lower dose was not formally used in the RELY study.  Without a large body of clinical evidence to support the use of the lower dose and understand potential risks, I do not use it.

Rivaroxaban (Xarelto) was the second drug available in the United States.  Rivaroxaban comes in two doses, 20 mg daily or 15 mg daily.  In the Rocket AF trial, rivaroxaban was at least as good and tended to be better than warfarin at preventing stroke (2).  Rivaroxaban also significantly lowered the risk of bleeding in the brain and head.  Bleeding in other locations was slightly higher with rivaroxaban compared to warfarin.  The lower dose is for people that have moderate kidney dysfunction.  This dose was actively studied in the trial and found to be both effective and safe.

Apixaban (Eliquis) was the third drug to become available in the United States.  Apixaban comes in two doses, 5 mg twice daily or 2.5 mg twice daily.  In the Aristotle trial, apixaban was at least as good and tended to be better than warfarin at preventing stroke (3).  Similar to the other drugs, risk of bleeding in the brain and head was lower.  However, this drug was unique in that bleeding from other sites including the stomach, bowels, and bladder was less.  Overall, apixaban due to better efficacy and lower bleeding improved survival significantly compared to warfarin.  Apixaban is the only drug that can claim that survival improved with its’ use compared to warfarin.  The lower dose is for people that have moderate kidney dysfunction.  This dose was actively studied in the Aristotle trial and found to be both effective and safe.

The biggest misconception about Antigoagulants is that they 'thin the blood'! They do not- they work in different ways on the body to prevent, or significantly slow down, the body's abiliity to clot.

I am now on lifelong anticoagulation, following recurrent DVT's and PE's. Whilst I wish that this was not the case, the risks to my life by not doing so are far too high.

I have taken Warfarin in the past, without any problems (other than the inconvenience of regular testing). However, after my latest PE in November 2014, my medical team could not stabilise my INR when on Warfarin, and I was suffering with itchy legs!

It was decided to try me on Rivaroxaban, pending an appointment with a Consultant Heamatologist. She advised me to switch to Apixaban, based on the fact that it has a significantly lower risk of an internal bleed than Rivaroxaban (and Warfarin).

I have been taking Apixaban for fourteen months now, without any side effects. I need to have an annual liver function test, as Apixaban works on the liver.

As for an antidote, my understanding is that one has been developed and awaiting approval.

Everyone will respond to medication in different ways. I hope that my story helps. Good luck with your own journey!

After looking closely at research published this year, I feel that Apixaban is  the best on most fronts, followed by Dabigatran with a somewhat higher bleeding risk.  The reversal agent for Apixaban has yet to be approved due to stroke concerns!  

Warfarin is a worry if INR is likely to fluctuate, as it often does.  An underdose increases stroke risk but an overdose is fatal by several routes.

What is clear is that atrial fibrillation is associated with much increased mortality, even with anticoagulants.  AF is associated with risk of stroke, CV-related death, chronic kidney disease, ischemic heart disease and, most of all, heart failure.  Cause and effect here is unclear.  In any case, anticoagulants can only reduce the risk of stroke. 

At 67 years, I'm still on low dose aspirin, every second day, because my risk for Metabolic Syndrome is low and my CHAD2 VASc is 1.  I may start Apixaban next year.  Until recently people like me would not have been put on an anticoagulant until 70.

Something to consider is Watchman. It is a device which is inserted into the left atrial appendage to block it off. Some literature holds that 90% of Afib strokes start with a clot forming in the left atrial appendage. If you can find a doctor who has done about a thousand of these procedures (okay, a little hyperbole there) the operation is not too risky. Many patients are off anticoagulants after a period of time for the plug to set in and seal off. 

Full disclosure: I opted not to have this done. My cardiologist told me, when I inquired, that the Watchman was the best among second choices to Warfarin. I have a friend who had it inserted and he is fine and off anticoagulants. Very confusing stuff.

Good luck.