I do still have my native valve.
Right. Good to know.
Pellicle, I will definitely turn to you if they put me on Warfarin instead of Eliquis. They all seem to think it's the better choice,
Eliquis (apixaban) is, for sure inferior to warfarin.
on this point:
even though Eliquis hasn't actually been tested for moderate to severe mitral stenosis (left out of the trial due to elevated risk, just like mechanical valves)
it has ... many times been tested on mechanical valves ... actually even more recently on the magic On-X valve
https://clinicaltrials.gov/study/NCT04142658
Brief Summary
Currently, warfarin is the only approved anticoagulation for patients with mechanical valves. The purpose of this study is to determine if participants with an On-X Prosthetic Heart Valve / On-X aortic valve can be maintained safely and effectively on apixaban. Both the On-X aortic valve and apixaban have been approved for use by the US Food and Drug Administration (FDA) but they have not been approved to be used together.
...and an evaluation of that study is done here:
The trial was stopped after 863 participants were enrolled owing to an excess of thromboembolic events in the apixaban group. Most (94%) participants took aspirin. A total of 26 primary end-point events occurred, 20 (in 16 participants) in the apixaban group (4.2%/patient-year; 95% confidence interval [CI], 2.3 to 6.0) and 6 (in 6 participants) in the warfarin group (1.3%/patient-year;
I am not a man of faith, I'm a man of evidence. Doctors love Apixaban because you don't have to monitor it ... as far as I know you can't readily measure its anticoagulation effect, and its marketed as a
one size fits all. Well we know how that goes with shoes.
Basically, in my view, if you can't measure it its faith based. Since science just demonstrated that "it works" to be a flawed assumption I wouldn't touch it with your barge pole.
This underscores my apprehension (aside from the many discussions Ross and I had personally in the past)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9163724/
There is no established role for direct-acting oral anticoagulants (DOACs) currently in these patients with mechanical heart valves, regardless of the presence of other indications such as venous thromboembolism and non-valvular atrial fibrillation.
13–
16 To prevent any ambiguity, the 2021 guideline update by the American College of Cardiology and American Heart Association clarified the term “nonvalvular atrial fibrillation” as not implying that VHD is completely absent; rather, “nonvalvular atrial fibrillation” indicates atrial fibrillation in the absence of moderate or severe mitral stenosis and mechanical heart valves—because patients with either of these two conditions were excluded from the key DOAC trials
Eleqis is apixaban and it is a DOAC. There was a reason why it was excluded ... trials had already shown it to be inferior in cardiac use. This was the subject that Ross and I used to discuss commonly.
On the subject of how to measure anticoagulation effect:
https://www.vet.cornell.edu/animal-...rpretations/apixaban-anticoagulant-monitoring
yes, thats a
veterinarian science posting (kinda how I feel about acitrom use)
How can I use the apixaban assay to guide therapy?
The apixaban assay measures drug levels based on its bioactivity as an inhibitor of Factor Xa (anti-Xa assay method). Measuring apixaban bioactivity will allow dose adjustment to prevent too much anticoagulant effect and risk for bleeding, or no anticoagulant action and inadequate therapy.
If my dog needed ACT I'd use warfarin and test with my Coaguchek ... my livestock (cattle, pigs ...) no, I'd just use apixaban.
Best Wishes
. 
