In a previous post we talked about the fact that NOACs make a lot of people uneasy, even though the data suggests that they’re often the better choice for afib patients.
And making the right choice can be difficult, since nobody’s really taken the time to sit down and line it all up: how each drug compares to all of the other drugs. In fact, sometimes even doctors aren’t sure which one to prescribe.
After all, there are now five different anticoagulants atrial fibrillation patients have to choose from to help prevent stroke. The old standby has always been warfarin (brand name Coumadin) having been around since 1954. There are now four newer anticoagulants to choose from called novel oral anticoagulants, or NOACs for short. They are:
Brand name listed first followed by the generic, or drug name, in parenthesis.
- Xarelto (rivaroxaban)
- Eliquis (apixaban)
- Pradaxa (dabigatran)
- Savaysa (edoxaban)
What factors should you consider when choosing a blood thinner?
The High Cost of Name Brand Anticoagulants
We all have budgets so cost is the first thing you’re going to have to look at when you’re sitting down with your doctor to determine which of these anticoagulants is right for you.
Here is the break down of the average costs of these drugs in the U.S. for a 30-day supply:
- $17 for generic Warfarin (5mg once daily)
- $340 for Savaysa (60mg once daily)
- $348 for Pradaxa (150mg twice daily)
- $418 for Xarelto (20mg once daily)
- $418 for Eliquis (5mg twice daily)
Source: Drugs.com
Fortunately, most patients aren’t actually paying these prices. In many cases health insurance covers a portion of these costs. You’ll want to check with your insurance provider to find out which of these drugs they’ll cover and how much they’ll pay for each drug so you’ll know what your true out-of-pocket costs are going to be.
Once you’re armed with that information you can communicate with your doctor which drugs you can afford. You don’t want your doctor to prescribe a blood thinner that you simply can’t afford.
How to Get Discounts on Blood Thinners
What if your doctor recommends one of these anticoagulants and it isn’t covered by your insurance, or the coverage you have is minimal? You have a couple options.
First, most of the pharmaceutical companies behind these drugs offer patient assistance programs to help significantly lower your out-of-pocket costs. These programs are for low income or uninsured and under-insured patients who meet specific guidelines, which vary from program to program.
These programs, however, can be tricky to apply for as you have to make sure all your T’s are crossed and all your I’s are dotted or you can be denied. Also, once you’re approved you have to go through the application process every year. Still, though, if you are very careful in filling out all the forms required and can remember to renew your applications every year, these are programs definitely worth checking out as they can save you hundreds of dollars.
Here are links to the assistance programs for these blood thinners:
- Xarelto – Johnson & Johnson Patient Assistance Foundation
- Eliquis – Bristol-Myers Squibb Patient Assistance Foundation
- Pradaxa – Boehringer Ingelheim Cares Foundation
- Savaysa – Daiichi Sankyo Open Care Program
If you don’t want to go through the hassle of applying for these programs yourself and you’d like to improve your chances of being approved (because you missed something on the application or filled something out wrong), there is another option. There is a service provided by Prescription Hope. They handle the application process for you and they take care of your annual renewals as well. Their programs provides patients access to over 1,500 brand-name medications including Eliquis, Xarelto, and Pradaxa.
Their service isn’t free, however. They charge $50/month per medication but even with that fee factored in, the cost savings you can get on these expensive name-brand drugs through the patient assistance programs can still save you a significant amount of money.
If you don’t qualify for an assistance program for the name brand drug of your choice, either directly or through a service like Prescription Hope, there is a second option – buy your drugs from Canada. I’ve done some research and the best prices I can find from Canadian pharmacies online are from YouDrugStore.com.
I buy my prescription drugs from them because I can buy them cheaper through them than I can even with my prescription insurance coverage here in the U.S.!
Here are the prices you’ll pay for a 30-day supply of these blood thinners at YouDrugStore.com:
- $141.98 for Pradaxa (150mg twice daily)
- $299.98 for Xarelto (20mg once daily; must buy 90 day supply so less than $100/month)
- $138.34 for Eliquis (5mg twice daily)
Prices as of 11/26/19. Savaysa not available.
How Effective Are Blood Thinners?
After cost considerations, the effectiveness of each of these drugs is an important consideration.
There are studies which compare individual NOACs to warfarin. The statistics say that the outcome is usually better for NOAC patients than for warfarin patients.
There is no real data, however, to compare the efficacy of one NOAC to another.
Some patients have other illnesses which prevent them from being able to take a NOAC so doctors are left with only one choice – warfarin.
And still some doctors are reluctant to prescribe the NOACs because they haven’t been on the market very long so they tend to favor warfarin.
One factor in the effectiveness of these drug is you. Doctors look at how likely you are to remember to take your medication. Eliquis is a twice-daily medication where Xarelto is a once-daily medication.
In fact, if you tend to be absent-minded doctors do, again, like going back to warfarin…if only because they know that this will put you under their watchful eye. Warfarin requires regular monitoring.
Anticoagulants and Kidney Function
Any kidney dysfunction in your body could have a serious impact on which drugs are right for you. NOACs are cleared by the kidneys. That means your bleeding risk goes up as your kidney function grows less effective.
People with kidney problems can tolerate Xarelto in low doses, as long as they take it with the evening meal. “Low doses” just means that you’re taking it down from 20 mg daily to 15 mg daily.
You can do the same with Pradaxa, but you have to lower the 150 mg dose down to 75 mg.
But when it comes to kidney patients, Eliquis might be the clear winner. You don’t even have to reduce the dose for Eliquis unless the patient has end-stage renal disease, and are on dialysis, and weigh less than 132 pounds, or are older than 80.
The Risks of Bleeding When Taking Blood Thinners
Blood thinners are designed to make it harder for your blood to clot. Unfortunately, this means opening yourself up to problems when, well, you really need your blood to clot.
Warfarin has an antidote. So if you get into a car accident and need to go into surgery, they can get your blood temporarily back to normal so that you don’t bleed out.
NOACs are working on similar antidotes, but they don’t have them yet. Some doctors do note, however, that specific antidotes are really all that is missing.
“While specific antidotes for each are on the very near horizon, they may be reversed with infusion of prothrombin complex concentrate,” he told MedPage Today. “With the expected rapid approval of direct inhibitors of each drug — which literally work within a matter of minutes — this issue should be resolved once and for all.”
Once reversal agents become commercial available, “then I don’t think there’s going to be that much of a role for warfarin at all” if patients aren’t already on it and doing well, Kirtane said.
5/14/18 UPDATE:All three of the major NOACs (Xarelto, Eliquis, and Pradaxa) have antidotes. Pradaxa’s antidote is known by the brand name, Praxbind, and the generic name, idarucizumab. The antidote for Xarelto and Eliquis is named Andexxa.
Which NOAC/Blood Thinner is Best?
The answer to this isn’t as cut and dry as you would think. The best NOAC, or blood thinner, is the one that is best for your unique health condition and situation. For some, Xarelto will work best. For others, Eliquis will be the best choice. And still others will do best on warfarin (or for whatever reason warfarin may be the only option).
There was a study published in November 2017, however, that demonstrated Eliquis as being the best NOAC for non-valvular atrial fibrillation. You can read about that study here.
Are you on warfarin? Are you doing well? Are you on NOACs? What’s your experience? Which drug did you ultimately choose?
Please share your comments and observations below.
Question on side effects of Eliquis. My afib was “cured” by hybrid Mayes procedure. Back surgery 35 years ago was successful. Oversimplified, but Too much golf, and old age, produced lower back and cervical disk problems.. steroid injections helped at first, then lower back surgery, cervical rods and screws and then lower back rods and screws left me with nerve damage. Finally to my questions? Eliquis ads mention problems from spinal processes. Executed Proper stoppage of Eliquis on all surgeries but probably not on steroid injections. IF some of my current leg numbness, foot fire and ice, or hypersensitive activity was caused by Eliquis combo and procedures—first, have you ever heard of that or any problem, but more importantly, Have you ever heard of anything that might reverse the problem? I haven’t asked my surgeons or written J&J because I’m not looking to blame. I don’t think anyone did anything wrong, but in my never ending search for something that can be fixed, I’m still casting around for info. Thanks
Dears, plz suggest, if after 3 months of medication, can 20 mg once a day , Xarelto dosage be reduced to 1 20 mg for 2 days? Is this by any way advisory? In my case, it was very minor clot in lung, and doctor said, should be OK within 3-4 months. Due to Corona issues, I may run out of dosage, so thinking to reduce dosage to save on tablets..??
The information for “Here are links to the assistance programs for these blood thinners:
… Savaysa –” in not accurate. this assistance does not cover savaysa. i wasted allot of time filing out the form, getting my doctor to sign only to find out it was not offered.
This is interesting and informative. I ended up having a PE back in 2009 after a long car ride, scrunched up in the backseat. I was asleep the entire 8 hour trip and I’m about 5’10. I was admitted into the hospital, released after a week with no instructions. I also had no insurance and since I had no place to go I begged them to let me stay an extra day. Filed bankruptcy after that too. Anyway, they had me on warfarin. I took it until my supply was out. Thought I was fine. I also moved to Japan early that next year.
In 2014, after a plane trip, I ended up with another PE. They were shocked at the care I’d received in the states. They put me on Warfarin, but realized it wasn’t too effective. Later on, I was put on Savaysa by the cardiologist.
I finally returned to the US in 2018 and living here. I had no idea it was such an expensive medication. For the past few months, I haven’t been taking Savaysa (can’t go see a cardiologist here due to lack of insurance). I’m back on Warfarin and my numbers are still a mess.
What I’m trying to determine is which of these medications are closest to Savaysa since there are no discount programs for it. Eliquis seems to be close, because if so, maybe I can get back on a medication like that as opposed to taking warfarin.
While I am waiting for reply on my comment and history, too, willing to add more here. Its well loud and clear now that medicine lobby had been misusing it for business in case of Heart attack and Diabetis such that the lab result range was subsequently trimmed and Doctors have a legal and solid ground to write those medicines. Its open and clear from recent US, UK journals and many online articles. Is there any similar in PE drugs? In 2013- I took Warfarin for 6 months. The cost in Saudi Arabia was @ 5 USD for 100 pills in plastic bottle. Now I am again on Xarelto which is @ 100 USD per 28 pills. And Doctor wants me to take for life…without sound diagnostics. I have wrote in my first post about my case, and was waiting to see reply from experienced or knowledgeable folks. Even I wish to state once again- how all of a sudden D-dimer can go high- without any travel or stagnancy? Were my acute stomac pains created bleeding in body/stomac and it caused blood clot some where in lower limb or pelvic and that got into lung? Is this activity possible within say 7-8 days time?
I cannot seem to find a definitive answer to the question whether and to what extent the traditional risk calculations should be adjusted for people such as myself who only have occasional a-fib episodes. There seems to be some logic, at least to me, of only taking anticoagulants during episodes, but doctors don’t seem to operate that way and I can’t find much on it in the literature. Any insight welcome.
I have a fib every 2 to 3 weeks and I would never take those blood thinners. I have known 5 people who have died from taking Elliquis!
Hello All- Fortunate to find this article on Google search.
I am Shailendra, 46 yrs old. 2013, I got into an accident and operated for Knee surgery. After 2 weeks, it resulted into DVT and PE into my left lung. I had been on Warfarin for 6 months. There after Dr. discontinued the treatment as read above. I asked for cross examination like doing chest x-ray or lower lomb US-Dopller. But Dr said not necessary. 3 weeks back 14 Dec 2019, it started with severe pain in right abdomen near to Naval area. The pain go radiating to back and more intense in night from 11pm till 5 am ( this is specific observation). All tests by Gastroenterology like USG, CT abdomen, other blood tests cleared with no problem- Only notably as report said – “”Fatty liver & right basal Pulmonary Consolidation, left basal atlectatic bands””. The pain reduced subsequently – dont know how ( were they digestive system related?). There after I personally met another Doctor who decided to work towards Pumonary consolidation. They found 2 very small clots 1-2 mm in 3rd artery of right lung. Xarelto is started now- 15mg twice a day. And Dr advising could have to take life long. My question – Is this called recurrence? Can such case happen after gap of 6 years? The first case 6 yr back- reason was post accident. However, second PE reason must be diagnosed before its decided to take medication for life. I read that internal bleeding can also cause clots. As said it started with severe abdomen pains that remained for 5 days ( No night sleep and just was able to sit on chair with a typical body posture weighing on left side to feel better or less pains). The pains automatically stopped after 4-5 days. Can such acute Abdomen pain cause internal bleeding and then it can become cause of blood clots? How long a blood clot in any area of body should take to get trapped in lung- in case of a patient who do not have much mobility?? I wish to avoid taking anticoagulants for life.
was switched to eliquis from savaysa my anemia has gotten worse am also taking cloprodiil and have a pacemaker the eliquis has caused constant small skin bleeds and bruising…. i,d like to goback to savaysa any reason not to. i’m 9w2 ..
I started off on Eliquis which made me extremely tired and nauseas , so switched to Xarelto, unfortunately I had so many side effects e.g. edema in lower legs, which felt like concrete blocks combined with an itchy weeping rash which was unbearable. Bleeding from the back of the throat which was scary, I really panicked the first time I wakened up with blood all over the pillow. also terrible nausea which I was able to resolve by taking it with the evening meal. Long story short, I saw my EP in December who suggested Edoxaban as he was finding it was better tolerated. I have now been on it since the end of December and not only have I had no side effects but the edema, rash and heavy legs caused by Xarelto has gone and I have had no more bleeding. The only downside for me is that although the cost of Eliquis and Xarelto was covered by OHIP (Canadian Health plan) unfortunately Edoxaban has not yet been approved for a fib, so it is costing me $115 a month but I feel so much better it’s a small price to pay and hopefully it will be covered in the near future.
I started with ITP (Idiopathic Thrombocyto Penia in 2012). I had my blood checked to determine my A1C on a Friday. The following morning I received a call from my doctor (not a receptionist or nurse) before I was even out of bed. He told me that a person with 10 or less (thousands) of platelets could have spontaneous bleeding anywhere in their body including the brain, which could cause a stroke. He then told me I was at 1. He directed me to go to the emergency department of the hospital, do not bump my head or shave or use anything sharp.
ITP is a condition of very low platelets. They treated me with 2 bags of plasma and checked me into the hospital, where I received Prednisone, which did not change my platelet count for the 3 days I was admitted. Then they used IVIG immune globulin intravenous and slightly bumped my platelet count but not significantly. More prednisone and sent me home. Then it was 1 day a week for 5 weeks, about 5-6 hours of infusion. Failed that.
Next was one day a week for 4 weeks of Rituxin infusion. I read the label as it was flowing into my body. The largest print on any label is the most important, the next largest is the next most important. Largest print: DANGER! Next largest print: HIGHLY TOXIC CHEMICAL! Hmmmm, failed the Rituxin.
So having failed 3 different chemicals the oncologist said there was just one more chemical to try, but insurance would not pay for it until I had my spleen removed. I had my spleen removed and my platelet count went from about 58 to 600+. I thought that would be the end of that but about 8 days later I was having abdominal pain so I had CT scan. The radiologist report said “massive near fatal clot” below my liver and another clot at the stump of the spleen removal.
I was admitted again and they got the clots under control. For several months I was on warfarin, going back and forth to have my INR checked weekly because it was very erratic. Each time was a co-pay of $65. Sometimes I went every 3 days when it was out of control. I asked the doctor about Xarelto. I’ve been on Xarelto ever since.
One morning I was having severe chest pains and went to the emergency room of a local hospital in Glendale Arizona. I had the “widow maker” heart attack. I did NOT have plaque buildup in my veins. I had fresh blood clots blocking the artery. I asked the family doctor how that could be since I have been on Xarelto for about 2 years at that point. He answered “You’re weird.” I had a stent put in and went home.
Prior to all of this, I was lifting weights and riding the exercise bike 7 miles three times a week. Not indolent and fat, in pretty good shape. I’ve been on Xarelto for more than 5 years now. I still work out pretty hard, and I’m 70 years old.
Two years ago I was diagnosed with lymphoma of the throat and tongue and underwent radiation followed by chemotherapy. Still working out hard but my cardiologist says I will he on Xarelto forever. GO figure…
6 months after being put on Xarelto because of a DVT in my left leg and a resultant BPE, the doctor took me OFF of it. I asked why and was told I had not had another clot so I didn’t need it. I asked if he patched his tire because of a flat, would he pull the patch off after six months because he hadn’t had another flat. He didn’t answer but would not prescribe it again.
I don’t want to die because he thinks I am cured but can’t show evidence of it. So I researched blood thinners that are over the counter and found Nattokinase. I think it works because my feet warm up after taking it. I also take CoQ 10 to clear the veins of plaque. I can’t take NSAIDS because they cause massive bleed outs rectally. My pharmacist thinks it is an appropriate medication.
Jim:
It does seem odd that they would take you off a blood thinner when you’ve already had a clot. You would be a classic case FOR blood thinners. If I were in your shoes I would probably see another doctor for a second opinion.
Nattokinase is a great natural supplement to thin blood but the problem is you don’t know how well it’s thinning your blood. You don’t know if it’s thinning it enough to prevent a clot.
I think your best course of action would be to get a second opinion.
Travis
I am an RN working in Critical Care. Every physician I have worked with has followed the same protocol. Patients who have had only one DVT (clot in a large vein) or PE (clot in an artery in a lung) are kept on anticoagulant therapy only for a few months. Patients who have a second clot are put on anticoagulants for life.
Unfortunately that doesn’t make it right to do so. Surely other factors should be considered such as the severity of the first incident. I had a massive clot develop in the back of my head which was unnoticed (no symptoms) until very late. Sudden headaches lead to a complete physical collapse, a small stroke, 2 days in a coma, double vision for about 6 months. My head Doctor in my case told my family on the day I was taken to hospital that I was unlikely to recover at all but if I did I would surely not have a fully functional brain. I was taken of anticoagulants when the double vision finally disappeared, brain mostly intact.
2.5 years later I went through a massive Pulmonary Embolism due to a clot forming in the major artery inches before it entered my heart. Again I was predicted not to survive. During recovery I suffered clot formation from my right foot up to and in my abdomen. Again I recovered but not without several ongoing lifelong issues including reduced lung capacity, daily substantial swelling of my right leg and visible damage to veins throughout my right leg.
I believe that taking me off of anticoagulants after the first incident was completely irresponsible and the 4 doctors involved in my recovery from the second incident all expressed shock that had happened upon learning how severe the first incident had been. They all said I should not have been taken off anticoagulants.
There cannot be a one rule for all situations. It makes no sense.
I had an extended episode of AFib w/RVR (longer than the little “blips” of AFib my ICD (hypertrophic cardiomyopathy) picked up in the past) in March 2018. My cardiologist prescribed Eliquis, but I wound up not taking it due to my history and risk of GI bleeding.
In April 2018, I had to have iron infusions due to severe anemia not responsive to supplements.
Flash forward to May 2018, I was diagnosed with left leg, from ankle to groin, DVT and BPE. After 3 days in hospital I was sent home on Eliquis. Woke up that Sunday morning, after 2 or 3 doses of Eliquis, bad GI bleed , so back to E/R, back to hospital, given Lovenox, etc… still had GI bleeding, finally stopped, sent home on Warfarin.
Doctors discussed the idea of taking me off Warfarin after a few months, but my GP and hematologist/oncologist decided I needed to stay on anticoagulants for life.
My cardiologist did say that the risk of bleeding is lower with Eliquis, and that I am just a complex patient. I am going to ask again if I can try Eliquis again, since there is an antidote now. It would be great to not have to go in for testing so often, especially because we live so far away, and all the other concerns about Warfarin.
I have found that if I take 400 mg daily , 200 in the morning and 200 at night I will have a small amount of blood in my urine. But if I just take 200mg in the evening, I dont have the bleeding. So I am using this as a measure for the correct dose. Which, for me, seems to be 200 mg daily. It has a half life of 12 hours which makes it fairly safe.
I feel it must be working since it has reversed a “cold feet” symptom that I have had for years.
Both my GP and the specialist at the hospital say I should NOT be on a blood thinner but my GP is accepting of the Nattokinase, in fact it was him who suggested it.
Interesting. Glad to hear the Natto is working so well for you!
Travis
What caused your clot? If it was by accident, eg after a long flight, it is normal that you only have to take the anti-coagulants for a limited time. To dissolve the clot and get the blood flowing properly again. It’s not a patched tire you have but a clogged pipe. When the clog in the pipe is gone, you don’t keep on pouring dissolving product in it, unless you are sure you’ll get a clogged pope again.
So, unless you have a genetic default that causes clogging, it is absolutely normal that after a first incident you are taking off anti-coagulants. My sister had a DVT during her pregnancy 22 years ago, she has been fine since. I’ve had 3 DVT’s since 2008, I’m on it for life since the third. If any (licensed) doctor would tell me it is safe without anticoagulation, I surely would stop!
What is important is to be active, to keep the blood flowing. Don’t sit still too long, don’t cross your legs (this is a lesser problem for men ;) ) because it stops the blood flow. Wear compression socks on long flights, and inject yourself (fraxodi or similar). When driving, stop every two hours and go for a walk. Eat healthily. It’s better to adapt your lifestyle than to take these pills if you don’t have to. I’m going to see my dad’s specialist because my mom said that he was not on anticoagulants at the end of his life and he had multiple DVT’s and PE’s.
Anticoagulants. CoQ10 might make blood-thinning drugs, such as warfarin (Coumadin, Jantoven), less effective. This could increase the risk of a blood clot.
Here’s a question for anyone/everyone who’s been on/ is still on an anti-coagulant:
Do you have anemia/ low red blood cell count?
I’ve read that non obvious mini/micro bleeds induced by even moderate anti-coagulation can add up (subtract!) causing mild anemia, which, in turn, causes tiredness, weakness, slow healing, palpitations. Yes. Palpitations can be a side effect of treatment for palpitations! That’s what the drug info sites list.
I’m wondering what Travis’s followers have actually experienced.
(I’m definitely among the tired and weak. Finding why doesn’t seem to be interesting to my docs.)
Hi Jeff, sorry you are having these problems, but interesting question, glad you posted.
I am not a medical pro, I just speak from experience. I’ve dealt with iron-deficiency anemia since age 4, I’m now 55. Currently I am having to get iron infusions because oral iron (double dosage) doesn’t work anymore, my body doesn’t absorb it for some reason.
I have several other health conditions (most inherited) that can cause those symptoms you speak of, as well as cause AFib and anemia. My doctors call me a “complex” case. Great, and thanks! ;o )
Long story longer, I would push until your doctor tested you for anemia, and addressed your symptoms. Anemia (among so many other health issues, AFib in itself, as you know) can cause those symptoms and make you feel lousy. I just don’t think anemia is the first thing that comes to their minds when dealing with men, for obvious reasons. But it does happen, and a simple blood test could rule it in/out.
Interesting side note: I was initially prescribed Eliquis (and had my Toprol way-upped) in March 2018 after a bout with AFib w/RVR. I couldn’t tolerate the upped Toprol, and we decided to hold off on the Eliquis due to my GI bleeding risk. Fast forward to May 2018, I had a DVT and multiple pulmonary emboli, hospital put me on Eliquis. Great. Wound up back in hospital with GI bleed. Discussed an IVC filter, but thankfully started Lovenox shots, then Warfarin, which works much better for me than the Eliquis. But I am still dealing with the anemia, and the other medical conditions/medication side effects, which can cause the same thing I am taking it to control. Nuts, and complex indeed.
Wishing you better health, Cheryl Shaw
I have read all of the comments and questions here, but never read where they can tell when they have A-Fib problems. My heart doctor just said that I have A-Fib and put me on Warfarin after one test. I never even suspected having anything wrong.
How does one decide when they are having an attack so they can help themselves? Also, every time I go in for a shot for pain, they take me off my medicine for five days. Don’t they think I will have A-Fib then? I just can’t figure out why I need to take it and have all these blood tests if I can go off it for days at a time. Does anyone have any answers for me?
Hi Eunice! I want to start by saying I am not a medical professional, just replying by what I have learned going through this experience.
Often, people don’t know when they are in AFib, others feel palpitations or an “off” heartbeat. You may also feel short of breath, fatigue, dizziness, weakness, nausea, and other symptoms.
Here is a great article that hopefully can answer many of your questions, but I would strongly suggest you ask your doctor these questions you’ve asked of this forum as well.
https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624
Many medications can effect how Warfarin works, and pain medications can increase bleeding risks, so that is why they make you stop the Warfarin for a few days. The benefits of taking Warfarin to help prevent clots due to AFib, and having blood tests to monitor your INR levels (as is needed with Warfarin) far outweigh the risks.
Once again, I would ask your doctor all these questions, and ask if he thinks you could go on a different, newer anti-coagulant, one that doesn’t have to be monitored with frequent blood tests.
Best wishes & good health to you….
Cheryl
Eunice:
It sounds like you have what’s called, “silent afib.” This is the type of afib where you don’t feel it. You don’t know when you’re in afib because you don’t feel any different. Because of this, they put you on Warfarin because you are at risk of getting a clot if you are having afib episodes and aren’t aware of it.
Have you ever worn a heart monitor? If not, you might want to ask your doctor for one. You could start with a 24-48 hour Holter monitor. This will give you an idea of how often you’re really in afib. You may find out you’re always in afib or you may discover you’re only in afib a couple hours every day. Without a monitor, you’ll never know how often you’re in afib.
If you are in persistent afib, meaning you’re always in afib, and they take you off Warfarin for five days, then yes, you are at risk of having a clot and a subsequent stroke. If this is a concern, I would talk to your doctor about it as I’m not sure what can be done in a situation like that.
Travis
I was diagnosed with AFIB a year ago and the cardiologist prescribed Pradaxa 120mg twice a day and Cardizem once a day. I stopped taking the Cardizem because of severe ankle swelling, itching and rash.
My cardiologist agreed but told me to check to see that my BP was stable. I noticed after a few months off the Cardizem I was having more AFIB episodes which lasted longer. I will see the cardiologist very soon to discuss whether or not I should resume the Cardizem. Your thoughts about manganese?
Anne:
I don’t know much about manganese so unfortunately I can’t help with that.
Travis
Anne. Do you mean magnesium instead of manganese?
My cardiologist prescribed Eliquis back in March 2018 for a bout of AFib w/RVR, but we later decided I was at risk for gastro bleeding so we decided against taking it for now.
Then, on May 24th, 2018, I was diagnosed with, and hospitalized for, DVT & multiple P.E.’s, and put on Eliquis. On May 26th I was released, but on May 27th I had to return to the ER and was re-admitted due to GI bleeding. I was then given Lovenox shots and started on Warfarin.
In the hospital I had problems with GI bleeding, but that was thought to be as the Eliquis was clearing out of my system. Once that happened, the GI bleeding improved greatly, and I’ve only had a few “light” episodes since being released from the hospital on June 4th, 2018.
So apparently, Eliquis will not work for me due to the GI bleeding, so Warfarin it is, despite the many trips for bloodwork, and having to watch my diet. In my understanding, Warfarin isn’t the best for AFib, but grouped with the DVT and P.E.’s, isn’t it better than taking nothing at all?
Cheryl:
Warfarin works just fine in helping to prevent afib strokes so I definitely wouldn’t worry about that. The primary drawbacks with warfarin, and why the NOACs are so popular, are that it requires constant monitoring and your INR levels can be difficult to maintain. And like all drugs, some people just can’t tolerate warfarin.
Given your specific health issues and the fact that the NOACs aren’t working for you, warfarin is a great option (and perhaps only option) for you.
I wish you the best!
Travis
Travis, maybe you can help me. Had clot June 2017, put on Coumadin, taken off Dec. Several ultrasounds since then clear. Had a blood test prior to major lumbar fusion surgery in March 2018. Did antiphospholipid syndrome test prior to surgery. Positive. Went ahead with surgery after consultation with hematologist. Lot of problems after surgery. Did not seem to get better.
Have post polio, centered left leg, no colon (J pouch since 1984), two knee and one hip replacement, polymyagia, arthritis, stage 3 kidney disease, sleep apnea, high blood pressure.
12 weeks after 1st blood test, second one proved positive so I was diagnosed with APS and put on starter kit of Xarelto. Amount proved too much for me, so finally Dr. dropped to 10mg. I am having upper arm pain, joint pain, leaking feces, nausea, weakness and tiredness where sometimes I can hardly pull myself around.
I am female, almost 79, living by myself. Have a prescription for Eliquis but took one and got very dizzy and opted to stay with Xarelto. I would now like to try Eliquis but I am scared. Nowhere do I see it mentioned that Xarelto or Eliquis is used for Antiphosphlipid Syndrome. Is it safe for me to take these drugs? I am so allergic to all medications. Thanks.
Mary:
You’ll definitely have to talk to a doctor on this one. As far as I know, Eliquis and Xarelto can be used for APS but you’ll want to confirm that with your doctor.
Travis
Thank you very much for your reply, Travis. You make this a little less complicated in your clear explanations. Best to you, Cheryl Shaw
I found pricepro Pharmacy out of Canada to be a third or the price for they also say they have a price guarantee and it’s the same drug by Bayer out of Turkey
Robert:
I’m not familiar with them but checking their prices on Eliquis (5mg tablets) for a one-month supply, it does appear to be way cheaper. Nice find!
I don’t know anything about this pharmacy, however, so I can’t vouch for them. Do your due diligence!
Travis
After aortic valve replacement I was switched from Pradaxa to Savaysa. My kidney function is normal. There is a warning that Savaysa may not be effective if kidney function is normal. Is that true? What is the advantage of Savaysa over Pradaxa for patients who have undergone aoritic valve replacement.
Neil:
Great question. Unfortunately, I don’t have a lot of knowledge on Savaysa. I am aware of their warning about normal kidney function but I don’t completely understand it all. Hopefully someone else reading your question can chime in with some info!
Travis
Travis,
This letter came to my attention recently.
Anticoagulation should NOT be used for non-valvular afib??
It is very difficult on any number of levels. I was hoping you’d have a go at it and share your opinion.
https://www.regulations.gov/document?D=FDA-2015-P-3410-0001
Jeff:
If you read this doctor’s petition, he’s arguing against warfarin specifically as an anticoagulant. His use of the term “anticoagulants” is very misleading. He should have just said warfarin. His entire petition is based on warfarin – NOT the NOAC’s. Quite honestly I’m not even sure why he references the NOAC’s in the petition. Unless I missed something he doesn’t site any evidence or studies against the NOACs. This doctor also wrote a book back in 2006 titled, “Money Driven Medicine Test and Treatments That Don’t Work.” In that book he argues against warfarin as well.
Travis
Actually, if you go back to the opening of the letter, under “Specifics Of The Action Requested”, He states – specifically – that all anticoagulants (and he names every one of the NOACs) should be contraindicated for nvAF.
I find I get lost in his reasoning.
Jeff:
Yup. That’s my point. He mentions that in the beginning but then the rest of the petition is about warfarin. That’s why his argument doesn’t make any sense. Warfarin and the NOACs are two different animals. You can’t lump them together.
Travis
I have been on Pradaxa since being diagnosed with A-Fib in 2013. My cardio doctor decided to change me over to Xarelto in 2015 but that caused kidney bleeding. He then changed me back to Pradaxa since I had zero health problems on Pradaxa.
With 2018 comes new formularies in which my Pradaxa is no longer covered. Doctor now recommends Eliquis but I’m skeptical. Will Eliquis cause similar side effects as Xarelto? If so, I’m not ready to shell out $83 for just a few days use. May have no choice since my Pradaxa would now cost me $400 per month (ouch). Anyone have kidney problems on Eliquis? Any other side effects I should know about?
Marc:
You’ll likely have no issues with Eliquis. As mentioned in the article, Eliquis is the preferred NOAC if anyone has any kidney concerns at all. The side effects for Eliquis are very minimal and for most people there aren’t any side effects at all.
Keep us posted on how you’re doing if you decide to switch to Eliquis.
Travis
I’ve been on Eliquis for a while now. No side effects. No kidney issues. Every doctor I’ve come across who knows of my afib has said that the important thing is that I’m on Eliquis.
Marc,
I’m curious… have you had an ablation done for your Afib?
My husband’s blood sugar sky rocketed out of control in the 300’s after taking Eliquis. Many people have this issue and the FDA apparently doesn’t know it. The other anticoagulants probably do the same thing.
He was just prescribed Xarelto for afib occurrence the 2nd time. I read liver issues big time with that, along with anyone having had spine problems or spine surgery shouldn’t take it because it can cause spinal or epidural blood clot. He just had C-3 thru C-7 cervical spine fusion 2 1/2 months ago. The doctor didn’t connect the dots. That’s why you need to do your own research. They can cause more harm than good when shelling out meds like candy.
I understand that the only blood thinners that have reversal are coumadin and pradax. So if you are on xarelto, eliquis or savaysa you will bleed to death. So it seems that it would be safer to be on coumadin and pradax since there is a reversal drug for this in case of emergency. Seems that eliquis which I am on now could be a problem. Very concerned if I were to have an accident and they could not stop the bleeding I would die due to this. Any information about this being a problem?
Jim:
I totally understand your concern about bleeding to death but there are a couple things I want to mention that might help put your mind at ease. When I brought this concern up with my EP when I had to take Eliquis temporarily for my ablation he said something to me that made me feel better. He said that “bleeding to death” is really only a concern if you get in a really bad accident – where you would likely have just as much of a chance of bleeding to death not being on a blood thinner.
In other words, the concern of bleeding to death because you’re on a blood thinner is really only a concern in very rare instances. We’re talking things like major car accidents, gun shot wounds, knife stabbings, etc. Even if you weren’t on a blood thinner you’d have a chance of bleeding to death as a result of these major accidents!
The other thing you should know is that the antidote for Eliquis (and all these NOACs) is under FDA review right now. The antidote is called AndexXa. It’s possible it will be approved and available sometime in 2018. Here is an article you can read about it:
https://www.biopharmadive.com/news/portola-andexxa-bla-approval-review/449368/
I hope this helps!
Travis
What a relief anyway! I’ve had been taking Eliquis since Dec 2017 and did not pay much attention about bleeding to death.
You are giving some really untrue advice that is misleading and could be harmful on a lot of these.
I have been told to take Xarelto for life?? Is it needed? Lets talk on that…
who dare to stop it/? I stopped it from 3 monhs… is that oK? I am alive…. Xarelto..shame on you.. you are takining money from people.. I am poor guy why you should do that? Come on .. comment need to be resonable,….. do not post just openion
I started with warfarin but was always having to have my blood checked because my numbers would fluctuate. It got to the point that scar tissue was forming in my vein. The vein in my other arm was harder to take blood from. I changed over to Eliquis and am happy not to do blood work anymore. I’m fortunate that I can get it for $94 for a 90 day supply through my Medicare advantage health insurance but the downfall is it puts me into the donut hole.
My A-Fib was discovered when I was having my every two year colonoscopy two years ago. Since this was all new to me and I never had any symptoms I decided to get a second opinion. The cardiologist asked me what prep I had used for the colonoscopy. I told her Citrus of Magnesium. She said not to use it anymore as it’s been found to cause A-Fib. My primary care doctor told me that another one of her patients was diagnosed with A-Fib also when having a colonoscopy.
I had an electrocardioversion 4 1/2 months ago and to date I’m still in normal sinus rythumn. The downside is I still have to stay on Eliquis because the A-Fib will likely return.
I noticed that Savaysa is left out of the discussion except to include it in the cost analysis. I was on it for 2 years and really liked it because no restrictions on time of day, with/without food, etc. and no discernible side effects. The cost is horrible, of course, and my initial lower cost has expired so I switched to Xarelto, for which my physician can still get me a discount.
My problem with Xarelto is having to take it with the evening meal, which is totally out of my routine for taking my medications and supplements – first thing in the morning and shortly before bedtime. I just can’t seem to remember to take another pill with dinner. I am on several pills for blood pressure, thyroid, etc. so I have tried to consolidate the times I take them into as few “sessions” as possible.
Is anyone else in this “community” taking Savaysa and if so, any thoughts on how to keep the monthly outlay low? Thanks.
Wendy:
Savaysa is “relatively” new compared to the other NOACs so that’s probably why you’re not getting a lot of replies from people. There just aren’t a lot of people on it yet.
As far as how to keep the costs down, I would Google “Savaysa Canada pharmacy” to find pharmacies in Canada that you can buy it from. It will be much cheaper than what you’ll pay here in the U.S. I would also look into Savaysa’s patient assistance program: https://savaysa.com/savaysa-support
I wish you well.
Travis
Hi, I am 79 years old, 145 lbs, active, and in great health other than developing afib 8 years ago. I only got episodes every couple years that didn’t last long but this year had several episodes in one month and my cardiologist insisted I take Eliquis (also started me on Metoprolol).
I started on 2.5mg 2x day with no problems and have not had any recent afib episodes since September. My question is, my doctor says I should take 5mg 2x day but as I am not in persistent afib and don’t have very frequent long episodes am I wrong in assuming 2.5mg 2x day might be sufficient (I could add an extra dose when I have an episode)?
I am 79 years old and had to have a pacemaker put in February 13, 2017 because Brady cardiac. Doctor has me on Eliquis. I have no prescription insurance. Since Eliquis is 375.00 for a month supply I looked for supplier with a decent price. I buy Eliquis through the Canadian Pharmacy. For a 3 month supply I pay around $270. At Walmart it is $365 for a 1-month supply (60 pills). Freight prepaid from Turkey.
I am a Caucasian male with an adult history of bradycardia (low natural heartbeat around 48-50 bpm), and a history of episodic AFib since age 42, which became persistent at age 68 two years ago. I am on Xarelto but am switching to Eliquis on approval of my cardiologist. I look forward to seeing approval of 1) the FDA-approved antidote, and 2) Eliquis available as a generic to reduce cost.
William:
I look forward to the same things – an antidote and a generic version. The good news is both should be available in the “near” future.
Travis
I was diagnosed with a DVT in my right leg and decided to use Xarelto. While I was on it my right leg always felt like it was slightly numb and it was always at he back of my mind what would happen if I had just taken a Xarelto and had a major bleeding incident. I did some research and switched to Eliquis once it was approved in Canada for treatment of DVT. I like that it was to be taken twice a day. My leg feels normal also. No insurance coverage so I am paying $122 for 60 2.5 mg tablets (@$98 USD) at my local pharmacy.
Bob:
Glad to hear you were able to find a better solution by taking Eliquis. The price you are paying for it is about as cheap as you can buy it right now.
I wish you well.
Travis
Very good article. A little history on me; long story short, I had a low heartbeat for years. It caused a mini stroke now I got a pace maker and the Dr. prescribed Eliquis. I have never taken drugs of any kind in my life. I am 78. I saw no need for prescription insurance. Guess what? Now I have to buy Eliquis and 3 more different drugs.
I discovered The Canadian pharmacy (very well established). I got my 3rd prescription today. This one was ordered through The Canadian pharmacy only it was shipped from Turkey. It was $99.00 for a month’s supply (60). I took my last bottle of pills I got from Walmart (a free supply from my cardiologist who installed my pacemaker) and made a comparison. It had the same numbers on the pill and the same package as the previous prescription from The Canadian pharmacy. I believe they are legitimate.
Steven:
Thanks for sharing your Canadian pharmacy resource. I went to their site and didn’t see the same price you purchased Eliquis for. When I go to their site a 60-day supply is $236. How were you able to get it for $99?
Most Canadian pharmacies are legit but the one I back 100% is YouDrugStore.com. I wrote an indepth review of them and recorded myself placing an order with them to show everything was legit. They sell a 60-day supply for $129.99/month
To read the review, go here:
https://www.livingwithatrialfibrillation.com/2364/youdrugstore/
Travis
I was prescribed Xarelto after a BPE that I was told, “Almost killed you.” Three months later they took me off it. I asked “why?”, “Do you know that I dont need it anymore?” I was told, “We will take you off it and see if you have another one. If you do, you will go back on it.” (if I survive the 20 to 1 odds of surviving a BPE)
If I have a flat tire and patch it. I dont, three months later, say, “Its staying up so I guess I will pull the patch off!”
The Dr told me that I cannot do what I did 30 years ago and drive for 12 hours at a stretch because my blood is not the same. My blood didnt change in the three months I was on Xarelto so why go back to risking my life.
The doctor said that its risky staying on a blood thinner, you might have an accident and bleed to death. The odds of that are about 1 in 10,000 but the odds of dying from a BPE are 19 in 20. Why would I risk a BPE to avoid a 1/10,000 chance of an accident that causes me to bleed to death!!!!!!! I must be missing something here ??? Maybe its because its not the doctor taking the risk…..hmmmmmmmm.
Jim:
For the benefit of other people reading your comments, and to make sure I’m on the same page as you, I’m assuming when you say BPE you are referring to bilateral pulmonary embolism.
I have no idea what your doctor is talking about but based on what you’re telling me I’d definitely go for a second opinion! I agree with your reasoning 100%.
The odds of you being in a freak truck accident that would cause you to bleed out is very low. And truth be told, if you were in such a bad accident that would cause such excessive bleeding, you’d likely die without the blood thinner in your system anyway.
I’d talk to another doctor and get on a blood thinner. You might also want to consider Eliquis. It requires you to take it twice a day so in theory it is safer than the other blood thinners as it “wears off” after 12 hours. It’s more complicating than that but you get the point. You might have a less likely chance of bleeding out from it if you get in an accident towards the 12 hour mark. At least that’s my understanding.
I wish you well!
Travis
Yes, Bilateral Pulmonary Embolism.
I had been sick and out of breath but still headed home on a marathon car trip (San Diego to Corpus Christi), been doing it for years with no ill effects. About 5 hours into the trip I passed out at the wheel and drove off into the desert and awoke before hitting anything returning to the road. I continued driving for another 7 hours. That evening I was completely out of it and couldnt even get out of the bathtub without help. The next morning I was fine. On getting home two days later the first Dr (heart Dr) I saw diagnosed it as carbon monoxide poisoning. and declared my heart healthy as a 30 year old. Nice to hear when you are 80…LOL
Several months later I was totally out of breath on climbing the 13 steps to my front door. I knew something was wrong as I am in perfect health working out at the gym three days a week. I went to the emergency room and was diagnosed with Pneumonia and sent home to rest. A week later I was “better” but that night I got up to go to the bathroom and had a pain in my left leg that was worse than any I had ever had, a 12 on a scale of 10, bad enough to send me immediately into shock. Three hours later I drove to my GP who looked at my leg and sent me to an emergency room that diagnosed it as cellulitis but sent me to a hospital by ambulance to do more tests.
The ER doctor at the hospital said immediately, “Its not cellulitis, its blood clots” and immediately shot me full of warferin. I was told that the left side of my body and BOTH lungs were turning to concrete and I had one chance in 20 of surviving. Needless to say, I survived and walked out 4 days later.
But, I dont want to go thru it again just to see if I need a blood thinner. I have survived Cancer, survived drowning, and survived BPE, I dont want to die for “testing”
Hello folks,
Pradaxa and other NOAC’s can have detrimental effects on the immune system. Apparently the immune system needs the blood to clot to work properly. There are studies right now that are investigating these effects. Anyone had any problems such as more viral infections, etc.? My husband has had A-fib about 6 years. He was on Pradaxa and could not tolerate it because of the viral infections.
Eliza:
Thanks for sharing! I wasn’t aware of the immune issue. I’ll have to look into that.
Travis
I am a 62 year old male that has had afib for about 3 years. I also learned I had aflutter. I’ve been told flutter is in the right atrium and afib is in the left atrium. An ablation is easier in the flutter zone and I had that done this past summer. The flutter is gone, they say, but the afib is still active.
To make a long story short, when I would come out of afib my heart would go into a pause. I’m now wearing a pacemaker for that. To complicate it even more, I have not been taking a blood thinner and a couple days ago experienced TIA…not fun, a bit scary, but after spending a couple days in the hospital running tests everything was good and they said all the symptoms point to afib. So I am now on blood thinner.
The neurologist prescribe Pradaxa. The cardiologist likes Eliquis. Neither are cheap, but after reading all of this I’m thinking Eliquis is the way to go. Any advice?
Tim:
If I ever have to take a blood thinner again I’ll take Eliquis. I had zero side effects from it. I also like the fact that it has a much shorter half-life (which is why you have to take it twice daily vs. once daily for Pradaxa). If you can get Eliquis at the same price or cheaper, I would go that route first. Otherwise if Pradaxa is cheaper I guess you can try that first and see how it goes.
Travis
P.S. There is also Xarelto to consider. That may be another option if Pradaxa or Eliquis don’t work for you for whatever reason.
Travis, I’m a 60 year old male that has Antiphospholipid Syndrome. APS has caused me eight (8) blood clots. The only anticoagulant that works for APS is Coumadin. Warfarin will work but it is manufactured by about 12 different drug manufacturers. The quality is NOT consistent. Coumadin is made by just ONE (1) drug maker, “Bristol Meyers,” this makes it possible to consistently keep the quality the same. So if anyone have Antiphospholipid Syndrome, Coumadin is the drug to use.
LeRoy:
Thanks for the great information! It’s greatly appreciated. I had no idea that warfarin was manufactured by so many different drug companies. I wish you the best!
Travis
Travis,
Your comment with regard to APS is off the mark. The question of efficacy of NOACs for ASPS is currently being studied by at least 2 large studies. Some prliminary studies were positive, some negative. One issue is that APS is not a homogeneous conditions. There are degrees of APS, among other things. And some of the coagulation failures involved APS patients with co-morbidities and “triple antibody positivity” APS. So the question is open regarding APS and NOACs.
Jerry:
Can you clarify what you mean by APS and what my specific comments were regarding it? I’m a little confused.
Travis
I believe Jerry is referring to Antiphospholipid Syndrome or ASP. I had a Bi-lateral pulmonary embolism about 8 years ago and was diagnosed with ASP and put on Coumadin as the only viable preventive at that time. After a couple of years having to get my blood checked every 3 months I looked for an alternative.
I did a lot of research and found that Plaquenil prevented clots associated with ASP. I talked to my Hemo Dr. and he was aware of the study and moved to Plaquenil and no problem since except new afib event which is why I saw this article. Plaquenil is finally becoming known as an alternative for ASP. Sometimes you got to do your own research. Talk to your doctor.
I was taking Warfarin and I got a bad batch. My 2.5mg went from 2.3 INR to 4.9 INR blood test. Threw those in the trash and got another prescription figuring I’d get in the 2.3 INR range again and after 2 weeks the doctor took another test and it was still high at 3.4. Now I’m finished fooling around with those manufacturers and started taking Xarelto. I’m looking here to see what is the best one.
Leona
Leona:
The “best one” is one that is best for you given your specific situation. Xarelto only needs to be taken once per day while Eliquis, for example, needs to be taken twice per day. If you are one to forget when to take your medications, then Xarelto might be better. I say “might” because the other consideration here is how you react to these drugs. You may tolerate Eliquis better.
Bottom line, I would work with your doctor to determine which one is best for you. In my opinion, the NOACs (Xarelto, Eliquis, etc.) are far better than Warfarin so you’re on the right track.
Travis
Coumadin and warfarin are one and the same. Just as Kleenex is a brand of facial tissue, Coumadin is a brand of the generic chemical warfarin sodium. It could well be that different sources of warfarin provide a slightly different product, but they all have to pass by the FDA.
If it’s an issue for you, you might consider that the brand name is always more expensive than the generic.
Have you noticed the ads on TV from law firms looking for people who died on the new blood thinners? I’ve been on Coumadin for 25 years for dvts lower legs. No problem and reasonable cost. If I crash my motorcycle it can be reversed.
Dan:
Yes, I have noticed those ads and they annoy the heck out of me! Ambulance-chasing lawyers drive me crazy. I suspect the bulk of the people in those cases have serious kidney impairment, which is why they have serious bleeding issues. If you are a healthy person with normal kidney function, the NOACs should be just as safe as Coumadin, if not safer over the long term.
If Coumadin works for you that’s awesome! But for a lot of people it’s not a very good option given the diet restrictions and regular testing required.
Travis
Those ambulance chasers are hired by the drug companies to do those class action suits because if you dont add your name to the list then after the suit you cannot sue! Its a method of getting rid of all the suits before the first one hits. Costs the drug companies less to settle a class action suit than to fight a bunch of separate suits that might be very expensive. Notice how those class action suits come out almost BEFORE the drug is on the market. Its insurance for the drug companies. They support them..
Im 70 years old and had many blood clots in the veins of my legs (deep vein thrombosis) and lungs (pulmonary embolism) last August 2015. Dr. prescribed Xarelto, and following the first free coupon, the monthly cost made me change to Coumadin. I hate all the don’ts of Coumadin and the weekly blood checks. Also, taking test require me to be off 6 days. Now I am on back steroid treatments.
I am changing insurance carriers and they require a letter to approve my change of medicine. I have not asked my doctor if I need to write it or does he. Also what would sway a provider to accept a more expensive drug? Thank you
Linda:
I’m not sure who would have to write that letter. As to your insurance question, this is where you have to have a strong relationship with your doctor so he/she can go to bat for you! If you can convince your doctor that you don’t tolerate coumadin (i.e. you suffer side effects, you can’t comply with the regular testing, etc.) he/she might be able to sway your insurance carrier to cover the more expensive drugs.
If that doesn’t work, then both Xarelto and Eliquis have programs that you can apply for where you get the drugs at a significantly reduced price – often just $10 or so for a co-pay! If those programs don’t work, you can buy these drugs from Canadian pharmacies for about half the cost.
I wish you well!
Travis
Travis,
My elderly mom was on Warfarin for approx. 6 years. She followed procedures to the T. Then she had a stroke! Her emergency doctor told her NEVER to take Warfarin again. They put her on two 81 mg. of baby aspirin daily.
She lived another 6 years. Now, my turn has come. I have a non-valve heart problem. I DO HAVE ATRIAL FIBRILLATION. New heart doctor wants me on Eliquis. I called my drug company. My copay for that would be $175 a month. I have no pain, never a heart attack, or no blood clots.
Can’t I just take 4 baby aspirin a day? I can’t afford the Eliquis. What do you think?
Sharon:
Aspirin isn’t recommended anymore for afib stroke prevention. I encourage you to check out this page I put together about aspirin and afib stroke prevention:
https://www.livingwithatrialfibrillation.com/2508/aspirin-for-atrial-fibrillation/
Eliquis does have a subsidized program. If you re-read the article above you’ll see I have linked to their subsidized program. I would start there and see if you qualify.
If you don’t qualify, then I would consider buying Eliquis from Canada. That’s where I get my Eliquis. I order it from YouDrugStore.com. It’s $130 for a one-month supply. The subsidized program would be the way to go, however, as I’m sure it’s much cheaper than $130/month.
How often are you in afib?
Travis
Pharmacy Technician here, the doctor would write the letter, or someone in his office. Lately I have noticed, at least with Medicare Part D, that getting these NOAC’s covered isn’t too difficult. Good luck!
Travis – I am a 65 year old lady having big problems with Afib right now. I have had a handful of episodes over the past 10 years never realizing what it was until this last time about a week ago when I had an EKG during an attack. Previously I thought it was just nerves. I saw the cardiologist who has me set up for an echo stress test next week and he adjusted my metoprolol to 100mg and added lisinopril 10 and samples of Xarelto 20.
I am afraid to take the Xarelto but have wrapped my head around the situation and ready to accept the fact that I have to take a blood thinner. Before I start one, I would like to know if, in your opinion, the Eliquis is safer and better. Then I will call the Dr. and ask for that instead.
It’s been a week already and this is wearing me down. The adrenaline attacks are awful and some nights I can’t sleep without taking a dose of lorazepam to calm me down.
Linda:
In my opinion, Eliquis is definitely safer. It is also known to have the fewest side effects of the new anticoagulants. For example, a common side effect and complaint of Xarelto is that it causes upset stomach. You won’t see that as much with Eliquis. Eliquis also taxes the kidneys the least. The only drawback to it is you have to take it twice a day.
Travis
I had A Fib for the first time in August 2016, I didn’t tolerate Eliquis well and switched to Xarelto. I took it in the morning and had really bad nausea but after switching to taking it with dinner in the evening the nausea went completely. I have been on it for 3 or 4 months now with no problems.
Esther:
Thanks for sharing your story. You prove my point exactly. The best NOAC, or blood thinner, is one that is best for you and your situation. We’re all different so we’re all going to react differently to these drugs. Glad to hear Xarelto is working so well for you.
Travis
I am a 42 year old woman with provoked dvt . 2-/ on Pradaxa for 3 days and had horrible side effects. Now on Xarelto for about 13 days but the heartburn/stomach issues are brutal and I am worried about hair loss, etc. Thinking of going to Eliquis but reports seems to be misleading for women. Any feedback is welcomed.
Tracy:
If Eliquis is an option for you and I was in your shoes, I wouldn’t hesitate to at least try it. You may find you don’t have any side effects from it. If you do, you can assess the side effects of it vs. Xarelto and choose the lesser of two evils:(
Travis
I am on Xarelto 20mg daily for shallow vein clots in left leg and in both lungs. I went into the hospital Aug 24th and was discharged Aug 28 with Xarelto. I am researching the alternatives as one of my doctors says I will be on this forever while the other says 3 months maybe 6 months. Since it’s free and once a day (easy to remember) and there may soon be an antidote, I tend toward taking it forever.
No one seems to know why I had the PE since I am very active going to the gym 3 times a week an hour a day. I am 80 years old and very active, race cars, airplanes, boats, and shooting sports (all subject to massive bleeding accidents…LOL). Since starting Xarelto 4 weeks ago, my feet, which have been cold for the past 5 years are now warm. My knees that in last 10 years ached are now pain free and my blood pressure is down to 114/70 from 135/80 (till 10 years ago it was always 110/60). My pulse rate is, as always, 75.
Except for Xarelto I take NO prescription medications. I like what the side effects Xarelto seems to have but hate that if TSHTF I will be off my medications without any options.
Jim:
I have to tell you, Jim, I’m inspired by your very active life at the young age of 80! Good for you. I just hope to reach the age of 80…lol.
It sounds like Xarelto is working very well for you. I’m not a doctor and I don’t try to play one on the internet either but one thing you could consider is Eliquis. It has a smaller dose option. It also requires two doses per day but that might actually work to your advantage. The reason you have to take it twice is because it doesn’t stay in your system as long. In theory, then, it could potentially be less hazardous in terms of having a major bleeding incident.
For example, let’s say you take your first dose at 7 a.m. and you get in a car wreck at 4 p.m., you’re just 3 hours shy of when you’d have to take your second dose. I don’t know the ins and outs of Eliquis but I’m guessing that in this scenario, at 4 p.m. the effects of it are wearing off or will wear off soon. Anyone with knowledge on this is probably laughing themselves silly as I might be talking out of my ass, but it’s just a thought. You might want to discuss it with your doctor.
Regarding an antidote, we were close to having one this year until the FDA’s recent rejection of AndexXa, the antidote that for Xarelto and Eliquis. Here is the link to the update on that:
http://drugsafetynews.com/2016/08/26/fda-delays-approval-xarelto-antidote/
Travis
Travis,
I don’t think it works that fast. It actually takes 48 hours for the anti-coagulation effect to disappear, about the same as Xarelto.
Pete:
The half-life of Eliquis is 12 hours so if you take a 5 mg dose at 8 am, at 8 pm you have roughly 2.5 mg in your system. 12 hours after that you have about 1.25 mg in your system.
What I don’t know is at what level are you at a “bleed out” risk. In other words, if you have 2.5 mg in your system, are you still at risk of bleeding out if you had a terrible accident? Probably so but I’m not sure. I need to do some more research on this topic.
Travis
I am a 90 year-old woman and was diagnosed with A-Fib two years ago. My cardiologist put me on Savaysa, a drug no one seemed to mention. He thought it caused less bleeding than Eliquis. This was before Xarelto came on the market. Do you or any of the respondents know anything about Savaysa? It’s expensive but no more than any of the other drugs in its category.
Ellen:
I don’t know much about Savaysa. Since it’s the newest of these type of drugs, there isn’t a lot of history behind it yet. And because Xarelto and Eliquis had a head start on Savaysa they own the bulk of the market so they are the primary NOACs prescribed.
If you’re doing well on it and it costs the same as the others I’d probably stick with it for now if I were you.
I had a DVT in my left leg. I am on Xarelto. When I first heard how much it was I was worried due do the high deductible for my insurance (thanks to the Govt). Luckily, I found a packet for Xarelto at my Primary Doctor’s office. They actually give you an insurance card to pay for any copays up to about $3,300, which covers my deductible.