Anticoagulation Clexane vs. Apixaban

[bmwmike]

Hi

Have been on Clexane injections for near enough 8 years and at my annual haem appointment the Doc convinced me that long term Clexane is not good as a preventative anticoag as it's more of an acute thing. So I am going to try Apixaban 2.5mg twice daily.

Anyone else on these? I have been warned about possible nausea side effect but other than that can carry on eating and drinking as per normal as I did on Clexane. Looking forward to not injecting but have the option to go back to Clexane if the tablets don't work out.

Thanks
Mike

[T0M]

I haven't heard of Apixaban, but my wife changed medication to Rivaroxaban (from Warfarin) due to huge INR fluctuations each week. That has worked just fine. 18 months ago she changed to Clexane due to wanting to start a family, but was told after this term Clexane was not advisable long term and must go back to Rivaroxaban afterwards.

[CinnamonFan]

I believe Rivaroxaban doesnt require a frequent INR testing. I assume (not 100%) that apixaban is a similar second generation anticoagulant drug. So perhaps it wont warrant an INR test either, opposite to Warfarin. Generally they can be used as a once daily dose also. Confirm with your GP?

[SiH]

Clexane (enoxaparin) is a Low Molecular Weight Heparin which is used to prevent the formation of blood clots (thromboprophylaxis). It's good stuff but it does have the disadvantage from a patient perspective of being an injection. Most people get used to this aspect of the treatment but given the choice most would also rather take a tablet.
Rivaroxaban which has the brand name of Xarelto and Apixaban which is sold as Eliquis are both factor ten a inhibitors (Xa - hence the names...) and they work in a different part of the clotting cascade to heparins and they're also a little more specific in their action. They don't need regular INR testing and I understand the post-marketing experience is generally pretty positive. If I were the patient in this position I'd probably go for apixaban as it's got better mortality data though I suspect that's more from the way the trials were designed rather than a true effect of the molecule. Warfarin is good, it's cheap and it can be relatively readily reversed but the testing is a pain and there are lots of external factors that can affect it (and hence the INR can be a little wayward at times). LMWHs like enoxaparin are also good but as an injection I'd say thanks but no thanks. The NOACs (which include the Xa inhibitors) - which incidentally used to stand for novel oral anti-coagulants, but as they aren't that novel any more now stands for non-vitamin K dependent oral anti-coagulants, are generally a good class of drug. I suspect that as the class comes off-patent with cheap generics in a few years time a good proportion of patients will be moved across en masse, rather like when losartan (a blood pressure lowering drug) came off-patent and also when simvastatin and atorvastatin (cholesterol lowering drugs) did.

[carinatauk]

I was on warfarin before I contracted to work in the USA for a while. The weekly tests were a bind to be honest.

I am now on dabigatran (Pradaxa) which seems to work for me and there is an antidote, as per warfarin, I am not sure that the others do have.

Apart from taking tablets it has been fine

[Turn7]

Bumping this to happily report I have finally been cleared to get off Warfarin and the PITA INR checks and will be going over to Rivaroxaban this week .

After many many years of Warfarin, this makes me very happy .

[Bonefish Blues]

I'm on a pre-trial to test giving people control over their anti-coag medication, only taking it when the wee device says I should, so am off apixoban and back onto low dose aspirin.

Said device hasn't told me to take it yet, since it was implanted in mid August, which is nice

[21TonyK]

^^ thats interesting. I've been on 10mg Apixaban for nearly 6 years and told its for life. I've managed to reduce most of the other stuff they put me on with changes to lifestyle and monitoring myself but the Apixaban is the one where I dont want to mess around!

Is it something my GP would be aware of?

[Bonefish Blues]

It's based out of the Oxford Cardiology Unit, they were looking for 50 people with Arrythmia and who are on anti-coags who scored against a set of criteria and who lived sufficiently locally. A pretty specific set of criteria, so not sure how many they signed up - I was the first implantation and it lasts for a year, but I got the sense that they'd be open to leaving me as-is until the battery ran out in c4.5 years.

[21TonyK]

Interesting stuff. It's not something that has ever caused me concern as such. The plus side is I get to the front of the queue in A&E if I'm dripping blood on their clean floor.

[Bonefish Blues]

I only have very occasional AF episodes so taking medication on an as needed basis seems sensible, particularly as the trial chap says they are so fast-acting there's no additional risk, plus there's no over medication.
I also figured that I have my own personal cardiologist on call with a direct line to my heart