A complaint about the 'new' anticoagulants

[Protimenow]

I have a friend who has had A-Fib for, he claims, nearly 70 years. He's had no negative events related to the A-Fib.
Recently, his doctors decided that he IS at risk, and prescribed Eliquis. He's had a lot of trouble with it. He's had a lot of bleeding just under the skin. When he cuts himself, he bleeds more than he'd like.

I've tried to interest him in warfarin - it's cheap, it's easy to manage, it's easy to reverse the effects. I've tried to tell him many times, but have given up. His doctors, apparently, know better.

Last week, he had a fall and landed on his butt. Aside from being a bit sore, he thought he was alright.

But he noticed, over the last few days, that his vision in one eye was getting bad. He was fortunate to get an appointment with an ophthmalogist yesterday. The ophthalmologist detected a bleed in his eye - most likely from the fall, and from the anticoagulant not clotting the blood quickly enough (true, wafarin probably would have given the same result).

But with the Eliquis, the doctor couldn't do anything to stop the continued bleeding. (If this was warfarin, a dose of Vitamin K would stop the bleeding in a day or so, and he can restart the warfarin once the bleeding stops, if it hasn't already).

The ophthalmologist left him without answers - other than to instruct him to continue taking Eliquis.

My friend's comment: 'I have bleeding in my eye, and they want me to take this pill that makes me bleed?'

---

I sometimes wonder how deeply in the pocket of the doctors who prescribe this stuff really are? Or is it a matter of brainwashing the doctors into believing that this expensive medication is an alternative to the inexpensive warfarin that, yes, does require some testing and management.

 

[Warrick]

Seems there is an antidote for eliquis approved by the FDA in 2018 called andexanet alfa

From what I can see with the “new anticoagulants” a big issue is the one dose size fits all and theres little available in the monitoring of the individual effects

https://www.eliquis.com/eliquis/servlet/servlet.FileDownload?file=00Pi000000TUgFZEA1

 

[Protimenow]

Actually, my friend is using Pradaxa.

My friend had what the ophthalmologist called an 'eye stroke.' There's another forum member (I won't mention her name) who has the same problem. At this point, I'm not sure if the pradaxa increased the risk or severity of the problem. I'm just hoping that my friend's problem doesn't worsen, doesn't disable him, and is only limited to one eye.

I'm not even sure that Pradaxa is responsible for the bleed, or if a similar fall, while on warfarin, or on no anticoagulants at all would have happened anyway.

Until I know more, I have to clarify that I'm not blaming the expensive alternatives for this particular problem.

 

[rich01]

I take Plavix, which is an anti-coagulent. Don't know if that is a similar drug or not, but I don't think it is causing me any serious side effects. I have cut myself a couple of times and bleeding has not been a problem.

I am having bad arthritic pain that started shorty after I had TAVR and started on Plavix, but don't know if it is related or not.

ETA: I hadn't made the connection between Plavix and arthritis until I made the post. Just looked it up and arthritis IS a side effect of Plavix. I'm surprised my doc didn't pick up on it when I brought up the sudden arthritic pain I was having.

 

[vitdoc]

I sometimes wonder how deeply in the pocket of the doctors who prescribe this stuff really are? Or is it a matter of brainwashing the doctors into believing that this expensive medication is an alternative to the inexpensive warfarin that, yes, does require some testing and management.

First very few physicians are getting anything significant from drug companies. There are a few “thought leaders” that go around and give dog and pony shows who get paid. Most physicians try to follow best practices.
There have been a number of studies suggesting that for AFib the novel anticoagulants may be better with fewer side effects than warfarin.
One could quibble with how these studies are done but they are what they are. So many people are put on these drugs due to these studies not because physicians are paid off.
As most here probably know these drugs did not work well for artificial valves so warfarin is still the only game in town.
Finally the “eye stroke” is probably a branch retinal artery occlusion. This is associated with embolic issues with AFib. That is why people are placed on anticoagulation who are in AFib. So in this case despite the anticoagulant this individual got a block. It happens. The incidence of embolic phenomena is significantly reduced with anticoagulants but it is still not zero. The fall probably had nothing to do with the eye issue.

 

[Warrick]

After I had my presurgery angiogram my radial artery blocked with blood clots , I was put on Pradaxa with no ill effects, it was only months later I read all the bad press surrounding it at the time.

Iv encountered several people in the last few years who have been on warfarin for afib and have been switched to Pradaxa, they generally think its great now because they dont have to have INR tests done.

 

[pellicle]

Pradaxa, they generally think its great now because they dont have to have INR tests done.

which is exactly why it was developed (of course). For quite a many people (due to either the system they live with/in or their views on life) INR testing is onerous and often skipped. For these people the new drugs are preferable to a poorly managed regime of warfarin.

 

[Protimenow]

Thanks for the clarification, Vitdoc.

Pellicle -- the meter manufacturers recommend self testing only for those who can do it. Non-compliant patients, those with physical issues that make it difficult to test, those with other issues that make testing difficult or impossible, and, yes, those who just don't want to do it or won't do it routinely, are excluded from this list.

As you said, the new drugs are preferable to warfarin (for patients with A-Fib or other issues where the drugs are approved for use). My friend probably won't be a good candidate for warfarin - he probably won't be able to self-test (although I can run a weekly test on him), and may be baffled by occasionally changing his dosage when his INR changes. For him, Pradaxa probably IS the best choice.

 

[carolinemc]

I sometimes wonder how deeply in the pocket of the doctors who prescribe this stuff really are? Or is it a matter of brainwashing the doctors into believing that this expensive medication is an alternative to the inexpensive warfarin that, yes, does require some testing and management.

First very few physicians are getting anything significant from drug companies. There are a few “thought leaders” that go around and give dog and pony shows who get paid. Most physicians try to follow best practices.
There have been a number of studies suggesting that for AFib the novel anticoagulants may be better with fewer side effects than warfarin.
One could quibble with how these studies are done but they are what they are. So many people are put on these drugs due to these studies not because physicians are paid off.
As most here probably know these drugs did not work well for artificial valves so warfarin is still the only game in town.
Finally the “eye stroke” is probably a branch retinal artery occlusion. This is associated with embolic issues with AFib. That is why people are placed on anticoagulation who are in AFib. So in this case despite the anticoagulant this individual got a block. It happens. The incidence of embolic phenomena is significantly reduced with anticoagulants but it is still not zero. The fall probably had nothing to do with the eye issue.

The reason I had an Eye Stroke was from not taking my blood thinner for three months. I have a St. Jude's aortic Leaflet Valve. Never been in A fib not one day in my natural life nor had a fall to cause the Eye Stroke. Just to educate you when a person stops taking any blood thinner, you run the risk of a stroke. I was lucky with mine, it was just at the left eye. Do not go by out dated studies. That the eye stroke is a rare occurrence.

 

[carolinemc]

Actually, my friend is using Pradaxa.

My friend had what the ophthalmologist called an 'eye stroke.' There's another forum member (I won't mention her name) who has the same problem. At this point, I'm not sure if the pradaxa increased the risk or severity of the problem. I'm just hoping that my friend's problem doesn't worsen, doesn't disable him, and is only limited to one eye.

I'm not even sure that Pradaxa is responsible for the bleed, or if a similar fall, while on warfarin, or on no anticoagulants at all would have happened anyway.

Until I know more, I have to clarify that I'm not blaming the expensive alternatives for this particular problem.

I had the eye stroke from stopped taking the warfarin for three months due to no insurance at the time. And could not go cardio with no income. You can mention my name as long as it is good wording. I learned a hard lesson. And hope everyone else can learn from it. It was not from a fall, I went to sleep and woke up with poor vision in the left eye. I went to the hospital for assistance and went to the emergency room and checked in, it is a hospital that help that have no insurance as well as those with insurance. I had to go in the hospital for three days to use bridge therapy to get back on Warfarin. I will never go without it again. But no fun with a legally blind eye. But I can see out of the right eye. My bad eye. LOL!

 

[dick0236]

The reason I had an Eye Stroke was from not taking my blood thinner for three months. I have a St. Jude's aortic Leaflet Valve. Never been in A fib not one day in my natural life nor had a fall to cause the Eye Stroke. Just to educate you when a person stops taking any blood thinner, you run the risk of a stroke. I was lucky with mine, it was just at the left eye. Do not go by out dated studies. That the eye stroke is a rare occurrence.

I didn't take my Coumadin for only several days in the 1970s before I had my "brain stroke". In those days, before INR, I'm pretty sure I was being monitored by my docs too low.....1-1/2 times normal PT, about 1.6?? INR. Lost my right-side vision in BOTH eyes......that was 36 years ago and my vision impairment never got better.......I am still 50% blind.......and it's a "pain in the ass". I have some simple advice for anyone on warfarin, or considering going on warfarin, take the pill as prescribed and test routinely.........you don't screw around with warfarin

 

[user 15848]

Thank you for sharing your experiences,

 

[pellicle]

the meter manufacturers recommend self testing only for those who can do it

As far as I know everyone pretty much recommends self testing only for those who can do it.

My view is that if one is reading and responding to this forum you're probably in that group.