When deciding what type of blood thinner is best, the question of Eliquis versus Warfarin often arises. Blood thinners, also called anticoagulants, are a class of medications that “thin” or prolong the time it takes for your blood to form a blood clot. Simply put, blood thinners stop blood clots. The usefulness of blood thinners comes from their power to prevent blood clots and reduce or eliminate blood clots that have already formed in your veins, arteries, or organs. This ability makes blood thinners an important class of medications for the treatment, prevention, or management of a variety of medical conditions including, but not limited to:
- Stroke in atrial fibrillation (AFib)
- Deep vein thrombosis (DVT)
- Pulmonary thromboembolism (PTE)
- Acute myocardial infarction (AMI or “heart attack”)
- Heart valve surgeries and certain heart valves
- Certain congenital heart defects
- Genetic or acquired hypercoagulable states
There are a variety of blood thinners, some of the major types include: vitamin K antagonists (coumarins), heparin or low molecular weight heparin (LMWH), direct thrombin inhibitors, and factor Xa inhibitors. For decades, the blood thinners of choice were Coumadin (warfarin) and heparin. Recently, however, several other medications known as novel oral anticoagulants (NOACs) are readily available. The available NOACs include: Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban), and Savaysa (edoxaban). The NOACs have been evaluated for the prevention of stroke in AFib and treatment and prevention of DVTs and PTEs. In this post we will compare and contrast Eliquis (apixaban) and Coumadin (warfarin).
What is Coumadin (warfarin)?
Warfarin has been safely used around the world for decades. Warfarin treats and prevents blood clots by decreasing the production of several vitamin K-dependent blood clotting proteins, hence the name vitamin K antagonist. Warfarin requires frequent laboratory monitoring and dose adjustment to maintain warfarin levels within a small therapeutic window, as measured by an international normalized ratio (INR) blood test. The INR range is determined by a physician and is specific for the particular medical indication. For most patients, the INR range is 2 to 3. This small therapeutic window can be very difficult to achieve in some patients. It takes about 5-10 days for the blood thinning effect of warfarin to begin and to wear off, so it must be stopped several days before any medical procedure or surgery. During breaks in warfarin treatment, patients may need to “bridge” themselves with other blood thinners to prevent blood clots until the warfarin levels slowly get back into therapeutic range. Most importantly for patients, certain foods that contain vitamin K (e.g. green leafy vegetables, spinach, brussel sprouts, kale, etc.) and certain medications (e.g. antibiotics, blood pressure medications, cholesterol medications, herbal supplements, etc.) can decrease or increase warfarin levels. These food and medication interactions make managing a patient’s warfarin level even more difficult. Warfarin is inexpensive relative to other blood thinning options and a month’s supply can cost $4.00 at almost all pharmacies. The NOACs are indeed more expensive than warfarin and the prices can vary depending on your health insurance coverage. However, the NOACs have been clearly shown to be cost-effective alternatives to warfarin. This is even truer with regards to Eliquis, when compared to the other NOACs, according to the United Kingdom National Health Services (NHS).
What is Eliquis (apixaban)?
Eliquis is a factor Xa inhibitor, all NOACs inhibit individual clotting proteins, thus inhibiting coagulation and making the blood thin. The ARISTOTLE trial showed that treatment with Eliquis prevented more strokes, caused less bleeding, and had an 11% reduction in death compared to warfarin. This “triple” advantage in AFib is true only for Eliquis; no other NOAC can make that statement. The 11% reduction in death was primarily from a reduction in cardiovascular death, particularly stroke deaths, because nonvascular death rates were similar to warfarin. Eliquis is similarly effective in comparison with warfarin for the treatment and long-term prevention of DVT and PTE, but has fewer major bleeding complications. Of note, NOACs are not recommended for patients with AFib and rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair. Overall, there is convincing evidence that Eliquis is consistently superior to warfarin and it is increasingly difficult to view Eliquis simply as an alternative to warfarin.
Eliquis has minimal interaction with foods and other medications, thus there are no dietary restrictions. Eliquis does not require laboratory monitoring or dose adjustment. However, the prothrombin time (PT) or anti-Xa activity can provide a qualitative measurement of the presence of factor Xa inhibitors. Eliquis is shorter-acting than warfarin and the blood thinning effect is quickly gained or lost after about 24 hours. Eliquis rarely requires bridging because it is shorter-acting and can be safely stopped a day or two before any medical procedure or surgery. A major criticism of the NOACs concluded that there was no way to “reverse” the blood thinning effect in patients who were actively bleeding. That particular limitation for Eliquis has now recently changed. Andexanet alfa was designed to reverse the blood thinning effects of factor Xa inhibitors. Recently, the first randomized control trial showed that andexanet alfa reversed the bleeding effects of Eliquis safely and effectively without any evidence of major side effects. Additionally in the future, four-factor prothrombin complex concentrate (4F-PCC or Kcentra) may have potential for reversing the bleeding effects of Eliquis in cases of acute bleeding or prior to emergency surgery.
Eliquis versus Warfarin: Which is the Best Blood Thinner for You?
It should be noted that there are no direct study comparisons between the different NOACs to date. However, for patients at risk for stroke in AFib, Eliquis is the only NOAC that is better than warfarin in the prevention of stroke and results in fewer bleeding complications. Based on the current available evidence it appears that, among the different NOACs, Eliquis has the most favorable risk-to-benefit ratio compared to warfarin. The favorable benefits of Eliquis compared to the other NOACs likely extends to the other indications for blood thinners as well, including DVT and PTE, but this has not yet been proven by any clinical studies.
So what is the verdict for Eliquis versus Warfarin? Eliquis is a very attractive alternative to warfarin, and even to the other NOACs, because of the improved effectiveness and enhanced safety profile for its FDA approved indications. However, the best blood thinner for you and your specific indication should be decided after a thoughtful physician-patient discussion.
Are Eliquis and Ami0darone compatibal?
Only caution is advised. This combination may increase apixaban levels, and potentially increase the risk of bleeding. However, this combination is used quite frequently in practice with a low incidence of adverse events. You should check your dosing and consider changing to amiodarone 200mg once a day, after a thoughtful discussion with your physician. Thank you very much for your question!
1) Any experiance with Eliquis in APLA synd.
2) Can Eliquis be taken concomitantly with clopidogrel?
Eliquis has not been studied in antiphospholipid antibody syndrome (APS), and it probably never will be. The recommended anticoagulants in APS are warfarin and heparin.
Yes, Eliquis can be taken with clopidogrel. However, the risk/benefit must be weighed and discussed with your physician as this combination may increase the risk of bleeding due to the additive antithrombotic (i.e. blood thinning) effects.
I am 65yo and one year ago had a saddle pulmonary embolism and DVT. I take warfarin 2.5 and they tell me will have to the rest of my life. Is Eliquis approved for long tem use for someone my age? I want the safest possible medication. I do enjoy a couple of beers and they tell me it’s ok because my dosage has been adjusted for it. Thoughts ,please?
It sounds like you had a very serious thromboembolic event a year ago, so yes, you will likely need lifelong anticoagulation. Eliquis is approved for long-term use in deep vein thrombosis (DVT) and pulmonary embolism (PE) with no dosage adjustments necessary, except for being coadministered with drugs that are strong dual inhibitors or inducers of cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) which your doctor should know to look out for. Eliquis is safe when compared to warfarin, and in some cases safer. However, if you have been stable on warfarin for a long time, then it would be reasonable to remain anticoagulated with warfarin. Eliquis would definitely be an option for you and I would discuss all this with your physician. Thank you very much for your question!
Thank you for your help. If only safe to age 80 what happens after that> Also what about me enjoying my beer with Eliquis?
For the treatment of DVT or PE, Eliquis does not need to be adjusted based on your age. For the reduction in the risk of stroke/systemic embolism in nonvalvular atrial fibrillation (NVAF), after 80 years old, the Eliquis dose might need to be adjusted based on your weight and kidney function.
If your baseline liver function is normal, none of the current anticoagulants have an interaction or contraindication with regards to mild alcohol intake.
This is just anecdotal, but I had a saddle PE and DVT, equally serious, just over a year ago. I’m 56. I’ve been on Eliquis since, and I am having side effects that are getting serious enough that I’m discussing Warfarin with my doctor. Specifically, incredible joint pain, back pain and neck pain that just won’t quit, numbness in my legs and feet, difficulty walking distances, insomnia, and general exhaustion that at times leaves me completely wiped out. Not bleeding issues or life threatening, but a genuine reduction in quality of life, that many others report as “I feel like I’ve aged 20 yrs.” Anecdotes abound around Internet board of similar reports, and, really, for all of the anticoagulants. It’s a bit depressing. But I’d say if you’re having a trouble free experience with any of these things, it seems like a good idea to keep at it?
People can have different reactions and experiences with the various anticoagulants. I would suggest switching to a different NOAC or trying warfarin, to see if that improves your symptoms.
Very interesting and informative article, Dr. Guichard. My father was an MD/GP and so I read and study many many medical, nutritional, and general health articles and publications. I really liked your style and delivery here, balancing nicely between difficult but necessary medical jargon, and easier to understand layman’s terms. This is my very first reading on anticoagulants, and I have gained a reasonable grasp of the subject through your very succinct, yet enlightening article.
I’m sure I join many others when I say,
Thank you very much.
E. J. Addington
(descendant of Henry Addington, 15th PM of England)
We work very hard to provide accurate and authoritative content that is hopefully easy to understand. Thank you very much for your kind words!
My question: if you are 90 years old (or older), got weak kidneys, and have been taken Waran for some years (since January 2014), with quite harsh side effects (due to the Waran) like losing hair, thinner skin (accompanied by bruises), as other symptoms, and in addition to that an instable food interaction, that means very high or low effects on the RNA-rate much due to a daily consumption of garlic (much garlic, which has shown to have a very good hart effect, something I would like to recommend others with weak hart), well here is eventually the question: according to description above, is Eliquis preferable to Waran?
Yes, one could consider Eliquis preferable to warfarin. In your case, no international normalized ratio (INR) monitoring required and no meal requirements or food restrictions (food does not affect the bioavailability of Eliquis) would be a major advantage. However, for the reduction in the risk of stroke/systemic embolism in nonvalvular atrial fibrillation (NVAF), Eliquis needs a dosage adjustment when at least 2 of the following are present: a) age ≥80 years, b) body weight ≤60 kg, or c) serum creatinine ≥1.5 mg/dL. Thank you very much for your question!
My husband is 87 and blood tests are being done to see if his kidney and liver functions will support a dosage of Eliquis. After wearing a heart monitor for 30 days, he was told his risk of stroke due to afib is 3%. Should he even be on an anticoagulant? He takes an aspirin per day, already has thin skin, easy bruising and bleeding with a slight scratch. He also drinks 2 glasses of wine per day.
It sounds like your husband’s CHA2DS2-VASc Score is 3, putting him at an adjusted stroke rate of 3.2% per year. Our professional society guidelines and clinical experience would recommend anticoagulation, preferably with one of the novel oral anticoagulants (NOACs) over warfarin. This is a general recommendation, each patient and their specific circumstances are different. All of this should be discussed with your physician, then you and your husband can make an informed decision. Thank you very much for your question!
Sounds like a few people need sleeve protectors for their arms. Their doctors/nurses should be telling them with decreased elasticity, decreased hydration, and at times decreased vit. d/e that their skin will naturally become thin. Increasing bruises, pupura, petechiae, turgor, and skin tears. Thinning hair also is a normal occurrence with many people as we approach geriatric years. I am currently on Eliquis, and thankful it is available. I understand factors can play a role in why some people are unable to be administered Eliquis. My father is on coumadin and many of my patients through the years, and just strictly my opinion (I do not want anyone changing medications just on my opinion because I am unaware of your situations) there is a plethora of reason I feel coumadin should be stopped. I understand if one has mechanical valve you must not take Eliquis, and with increased age one needs adjustments. My concern/thought though is why would any doctor keep a patient on coumadin after a certain age. Yes, anyone can fall or get cut but the elderly have such a high fall rate. Then, taking the increased injury rate when they fall, Eliquis would be so much safer coumadin. I would definitely pontificate over not just medications side effects, but the potential “non medication” side effects that could happen with ones body! Holistic thoughts are important #team Eliquis lol!!!! Thanks for this informative page and hope I didnt step out of line stating my opinion/asking question
Yes, as you suggested, there are a lot of variables when deciding which anticoagulant is best for you. Additionally, many of these variables are different from patient to patient. This is why it is critically important to have a thoughtful and informed conversation with your physician when an anticoagulant is needed, then make the decision that is best for you or your family member.
I have 48 years with no blood problem history. My dad had thick blood and had to take Sintrom for the more than 20 years.
I made a long segmented travel (Montreal – Geneva – Beirut – Dubai) . Doctors identified a severe superficial thrombophlebitis after this travel knowing that my blood thickness is normal. They put on Eliquis for 3 months.
My question if I have to take blood thinner all my life or it was just an accident.>Thanks
No, you should not have to take a blood thinner for the rest of your life. You have two positive factors: #1 – your blood clot was superficial (not deep) and #2 – your blood clot was provoked by a reversible risk factor (prolonged air travel). In your case, first episode deep vein thrombosis (even though yours was superficial, not deep) with a major reversible risk factor should be treated for 3 months and then should stop after 3 months of therapy. However, the ultimate decision can be determined between you and your treating physician. Thank you very much for your question!
First may I say thank you for this article. Well written and very informative. I had a mild stroke in August and a prolonged episode of a.flutter in late September. Ablation in mid October. They were able to put me in a.fib while on the table but I did rapidly convert. The decision for me of course is will I stay on Eliquis. I am a 52 yo male with well controlled BP. Any recent studies about the the risk of a.fib in post ablation patients such as myself?
Ablation procedures can be very effective, atrial flutter ablations even more so than atrial fibrillation (AFib) ablations. AFib ablations have several variables when it comes to effectiveness, but generally, in a patient with few comorbidities and favorable ablation substrate the success can be 70% or greater. However, it may take 1-3 AFib ablation procedures in total over the course of several months to years. You should remain on anticoagulation if required, because your stroke risk does not change, but hopefully your heart will remain in a normal rhythm. Thank you for your question!
i am 82 years old, in good health and very active. i had my aortic valve replaced in 2010 and developed a-fib before i was released.. the hospital restored normal rhythm but the a-fib reoccured one year later & again in 2015.. have been taking eloquist & multq 400.. now my insuranceco says no to the eloquis because the FDA wont approve of this medication for a-fib if you have an artifical heart valve.. i thought because i had a cow valve & not a mechanical valve that it should be approved. i note in your article”eliquis vs warfain” you indicate that not to take eliquis if you have a mechanical valve.. have you changed your position or do you still think its ok for me to continue the eliquis.. i hate the thought of gooing to warfain & having to watch my diet & the ongoing blood test.. also if i had the ablation would that eliminate the need for the blood thinner??
The novel oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) are not recommended for patients with AFib and rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair based on the 2014 AHA/ACC/HRS guideline for the management of patients with AFib (https://www.ncbi.nlm.nih.gov/pubmed/24685669). However, more progressive recommendations state that “nonvalvular AFib” refers to AFib that occurs in the absence of mechanical heart valves or moderate-to-severe mitral stenosis (usually from rheumatic disease) and suggest that other valvular disorders were commonly included in the NOAC trials and can be appropriately treated with these medications. AFib ablations are only a therapeutic tool for patients with symptomatic AFib and do not eliminate the need for a blood thinner.
My husband had a spinal fusion surgery. Does Eliquis then interfere with his mobility and legs?
No, it should not. After recovery from surgery, and when the surgeon allows resuming anticoagulation, Eliquis can be continued under the guidance of your prescribing physician.
Dr. Guichard, I am looking for your scholarly article hopefully done on this subject. Please help if available. I need that reference. re; Eliquis vs Warfarin.
I have not published this information as a review article. There are multiple references to support the information presented, which are hyperlinked within the blog post. Thank you very much for your kind words and interest!
I had a stroke in 2010 for which no clear cause could be found – I attribute it to the treatment (Rituxan) for NHL-MALT Lymphoma, which ended about 6 weeks before the stroke which went off and on for 3 days before I went to the ER. (My symptoms were not the ones usually listed for a stroke. I was found later to have Factor V Leiden from one parent.)
Then in 2015 I had surgery for small intestine blockage +resection and during the surgery developed A-Fib. I was put on Warfarin in the hospital (5mg) and had bleeding which delayed discharge for 4 days. Then I was put on Warfarin when I was discharged which I took until Feb. 2016 when I had another bleed for 24 hrs. from the bladder again. I was constantly having to have my INR checked and the range was set at 1.5 -2 and took almost weekly changes. After the last bleed I stopped taking Warfarin. However, my cardiologist says my risk for another stroke is 14% and wants to put me on Eliquis. Needless to say I am not anxious to take another blood thinner. I am 81 yrs. old and have multiple medical problems.
I realize this is a much longer question than the others, but I want to know more about the risks of trying another blood thinner. If this is too long to include here I understand.
There is no easy answer here, I am sure you already know and understand that fact. With regards to your history, it is likely that the stroke you experienced in 2010 was probably due to atrial fibrillation (AFib). We now know that a large percentage of strokes from an unknown cause, are later to be determined to be from AFib. The fact that you had detected AFib in 2015 after your surgery, increases my suspicion even more, but that is in the past now. With regards to your anticoagulation status now and in the future, I agree with your physician, your future stroke risk is quite high. Ultimately, the decision to take a blood thinner is up to you. Eliquis has been shown to be a safe and effective blood thinner, with an acceptable bleeding and side effect profile. Eliquis may be worth a try under the guidance and supervision of your physician. Bleeding can be a little problem, but a stroke can be a big problem. Like I said before, there are no easy answers here, but it sounds like you are educated about the pros and cons and can make a well-informed decision. Thank you very much for your question!
Thank you for your informative answer. I have now agreed to take Eliquis and will start it tomorrow although I am still a little anxious about taking another blood thinner.
My mother is on Coumadin as a preventative. She has been diagnosed with congestive heart failure due to a change in heart shape from amyloidosis. This then changed how her valves line up. She is also on blood pressure and cholesterol medicine. I have heard that Coumadin impacts memory. Is that true and if so, how do the others stack up regarding memory loss?
That is not true, Coumadin (warfarin) does not impact memory. The NOACs also do not impact memory. However, we have not been using NOACs for many years like we have with warfarin so we cannot say for sure. The bottom-line is that anticoagulation with warfarin, or the NOACs, should not alter memory.
Eliquis is 75% more than Coumadin (warfarin). However it has been noted that Eliquis is the ‘best for atrial fibrillation and preventing strokes’ and it is also one of the most expensive medicines I’ve ever seen. Are there generic medicines in the works? How long before those are seen? Will the cost be comparable to Coumadin or a few dollars less than Eliquis? When one is on a limited budget with Social Security, retired, and having to continue to pay for medicines and doctors that only increase and do not decrease it is hard to decide which part to save, the heart…the mind…the eyes..the hips…etc. Anything that can be done? or any advice? Thank you. Have a great day!!
You have legitimate questions and concerns, that many older Americans have, but at this time there are no easy answers. It will be some time before any of the NOACs become generic, but when they do it will be great for the many patients with AFib requiring anticoagulation. I think it is important to remember that Coumadin (warfarin) was and continues to be a great medication for it’s intended purpose. In fact, there are still many indications for anticoagulation that only warfarin is recommended. If you are having major financial issues, going with warfarin is a reasonable choice. Close monitoring of the therapeutic effect of warfarin with frequent INR checks can keep you safe from bleeding and protected from strokes.
my aortic valve has been replaced with a cow valve and following surgery developed a-fib which has occurred twice in the six years.. i have been on multaq 400 and originally pradaxa ans now eliquis since then.. now plan D medicare thru United Health Care has deneyed coverage of the eliquis.. the basis of their decision is “eliquis is not approved for a-fib in a patient with an artificial heart valve”.. should not that ruling apply only to “‘mechanical”valves and how can i convince them othwise??
I understand how this could be confusing and frustrating for you. However, the novel oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) are not recommended for patients with atrial fibrillation and rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair.
Hi, I have one functioning kidney which just had a artery deviation (a tear in the artery) resulting in a thrombosis( artery to the kidney) resulting in permanent damage to a small section. my current creatinine level ranges from 1.65 – 1.8. I am 37 yoa with no drug use and no history of drug use.
It is believed that the kidney that does not work any more suffered the same injury potentially 30 years ago.
I don’t use tobacco products either.
I drink very minimally (for the past few years)
Is Eliquis okay for me? 5mg 2x daily
Treated at MGH.
Yes, that dosing is appropriate. The reduced dosing, Eliquis 2.5 mg twice daily, is the recommended dose for patients with at least 2 of the following: age ≥80 years, body weight ≤60 kg, serum creatinine ≥1.5 mg/dL.
My creatinine has been in the 1.63 to 1.80 (mainly 1.63). My cardiovascular Dr. Is worried that eliquis will not work the same as Coumadin with a dissection in the artery to the kidney which has a thrombosis. Any advice? Will eliquis work? My Dr. Is Concerned that there is no studies on this.
My PCP pushed eliquis and I switched from Coumadin. Now I’m in a strange spot where I am being told that I would have to spend a week in the hospital on a Heparin drip to switch back to Coumadin because of my kidney disease.
Once again anything you have would help.
Yes, your cardiologist is correct, there is no indication for NOACs in treating renal artery thrombosis. There is no data, no FDA approval, etc. This would be an “off-label” use for Eliquis. However, in medicine, we use medications off-label all the time – you just need to understand that what you are doing has not been tested. I would tend to agree with your cardiologist about going back on warfarin, but the real question is, do you need to remain on warfarin long-term (i.e. forever) or has your acute event now passed? That is a question that you need to discuss with your physician. Also, you may not have to be in the hospital for a week, warfarin levels can sometimes get to therapeutic levels in 3-5 days.
I have been prescribed Eliquis, but am concerned about the possibility of needing emergency surgery or to stop significant bleeding should it occur in an accident, etc, without the ability quickly to reverse the effects of Eliquis. You mention clinical trials of Andexanet alpha as showing effectiveness in reversing these effects. That’s great but my question is: what if someone were to need to reverse the effects of Eliquis in such a situation tomorrow, or next week or month. Would the attending physician be in a position to use Andexanet? Or the other means you mention, 4F-PCC? Or are these still at a stage of development where physicians cannot yet avail themselves of them? If they are not yet available, what then? I’d be very grateful for an answer. Thanks in advance.
I understand your concerns, but I would not be overly concerned about the need to emergently reverse the anticoagulant effects of the NOACs – Eliquis in your case. Currently, the four-factor prothrombin complex concentrate (4F-PCC or Kcentra) can be used in emergent situations. There are other options being developed, these should be approved and readily available in the coming months/years. If you do have strong feelings regarding a “reversible” anticoagulant, you can always switch to Pradaxa (dabigatran) which uses Praxbind (idarucizumab) as the only FDA-approved specific reversal agent for a NOAC available.
I have had heart arythmia which developed into Afib. At this point I was put on Eliquis (Apixaban). However, a cardio reversion in April 2016 was successful and I remain in sinus rhythm (most of the time as far as I am aware). A follow up cardio CT scan revealed a significant stenosis (nearly 90%) in the LAD and an MRI stress test determined microinfarctions (<1g) in the distal LAD and distal RCA territories. My GP is now wants to take me off the Eliquis and substitute low dose asprin(75mg/day). I am somewhat apprehensive about this as I feel that I could revert into Afib at any time and, in any event, Eliquis must offer less risk than Asprin with respect to potential stroke?
Yes, I understand your concern. As physicians we use a calculation, called The CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk, to guide our decision about long-term anticoagulation for AFib. In general: 0 = may not require anticoagulation; 1 = consider antiplatelet (aspirin 325mg everyday) or anticoagulation; 2 or greater = should otherwise be an anticoagulation candidate. Every patient is different, and this score is just a starting point for a thoughtful conversation. I am not sure what your score is, but your physician should be able to tell you, then discuss the pros and cons of anticoagulation. Also, your coronary imaging is somewhat concerning and that should be addressed as well. Without knowing your complete medical history, I would say that anticoagulation with Eliquis (for your AFib) and starting aspirin 81mg every day (for your presumed coronary artery disease) could be beneficial.
Dear Doctor Guichard,
I had blood clots in my leg, and my doctor started me on Warfarin. 6 months later, my ultrasound showed that the condition was resolved. My doctor wants to keep me on blood thinners, but they make me a little light-headed. I switched to Eliquis, which make me even more tipsy, (like 8oz. of beer, continuously) and my arm muscles feel weaker. My question is: Do you think I could quit the blood thinners for a year or two, then take them again for 5 or 6 months to clear any clots that may have been forming? If not, is there a blood thinner that will make me feel “normal” while using it? I’ve stopped taking Eliquis, and am going to switch back to Warfarin. Thank You!
Anticoagulants should stop after 3 months of therapy in patients with an acute, proximal deep venous thrombosis (DVT) provoked by surgery rather than shorter or longer treatment courses. Anticoagulants should also be stopped after 3 months in patients with a proximal DVT provoked by a nonsurgical transient risk factor over shorter or longer courses. Anticoagulation should be given for 3 months in patients with a first unprovoked DVT and a high risk of bleeding, but should be extended without a scheduled stop date in patients with a low or moderate risk of bleeding. I am not sure which category your particular case falls into, but I would discuss this with your physician. Patients usually tolerate Eliquis very well, but in your case, warfarin should be just fine.
I was diagnosed with Superior Mesenteric Vein Thrombosis in 2014, they could not find the cause of the blood clot so they have put me on warfarin for life. I have to take 11mg a day to stay in theraputic range and have experienced a lot of bloating since taking warfarin. Would Eliquis be a better choice for me and do you agree with blood thinners for life, thank you.
Eliquis is technically not approved for the treatment of superior mesenteric vein thrombosis, so this would be an off-label use, I would discuss this with your physician. And, yes, I do agree with blood thinners for life.
Hello Dr. Guichard,
First of all thank you for so many wonderfully detailed responses. My 53 year old husband had a DVT in the popliteal vein just above the knee and ‘multiple’ small PE’s in both lungs. He is positive for heterozygous Factor V Leiden, and has taken a single baby aspirin daily for the last 20 or so years. In the last month he traveled much more than normal ( a cross country four day drive the first of December and two cross country flights in late December and early January ) so it is thought that these precipitated the conditions. He had a Lovenox shot in the hospital and was then prescribed Eliquis for 3 – 6 months. My question is this: We saw his PCP today who also said he can essentially go on or off Eliquis after the 6 month period based on if travel needs should arise again, but I have been reading and researching and have found many who state that Eliquis should not be stopped quickly or without tapering. In your professional experience can Eliquis be used in this manner, sort of like the former baby aspirin therapy ( which he incidentally has stopped while on the Eliquis) ?
In general, repeatedly starting and stopping anticoagulants is not a good idea. I would recommend being on Eliquis lifelong. Factor V Leiden is a weak risk factor for developing venous blood clots, but a risk factor nonetheless, and he already had a DVT and PTE once. Eliquis is well-tolerated, and given his current situation, I think the benefits of continued anticoagulation outweigh the risks. Thank you for the kind words!
Hello Dr. Guichard
I’ve had two DVT occurrences about 25 years ago, was on Warfarin for about 15 years, stopped using it (a bad decision) then had a PE about two years ago. Currently am back on Warfarin and also Plavix as I had some arterial leg problems last year and a stent. Aside from all of this I’m in good physical condition.
The problem is I am having problems controlling my INR.
Should I be considering (with a discussion with my physician of course) dropping the Warfarin and replacing it with Eliquis?
Thanks for any help you may provide
Yes, Eliquis could be a better anticoagulant option for you. You will need anticoagulation lifelong, if no contraindications, given your history of recurrent DVTs and PTE. Eliquis is safe and effective when compared to warfarin for DVT/PTE, definitely worth a discussion with your physician.
Dear Dr. Guichard,
Thank you very much for this article and your informative responses as well. My boyfriend is 22 years old, very healthy, and an active former football player. He found out yesterday that he has a DVT in his lower leg. He has been traveling more often during the past 2 months (around 1-3 hour drives every other week) and the physician from the hospital said that that could be the cause of this problem. He was prescribed Eliquis and before he sees his family doctor tomorrow, I just wanted to hear your opinion on whether or not that is the best medicine for him to be on considering his health and age. (I am very nervous for him to be on blood thinners in general for the first time because he is so accident prone.)
Is there anything else that he needs to be doing to break the clot up quicker? And should he be on limited mobility? The physician from the hospital said that most physical activities need to be discontinued for 6-12 months.
Thank you very much for your time and help that you may provide.
Hello!
My mom 90 years old started taking coumadin 7.5mg because she was diagnosed with DVT of the right leg. She totally lost appetite, feels much weaker then before, and can not even think about eating the food.
Is it possible to switch her on Eliquis? She also has heart valve aortic stenosis.
Thanks!
Based on what you have described, Eliquis may be an option. You will need to discuss with your physician the possibility of Eliquis because there may be some contraindications that are unknown or dosage adjustments that are needed based on age, weight, and kidney function.
Dear Dr Guichard,
I was diagnosed with Arrythmia in Sept 2016, although I am in sinus rhythm most of the time (65yo female).
I have been on Warfarin and Verapamil (beta blocker). However,I broke my leg in January and was put on Clexane instead of Warfarin. I am seeing my Doctor tomorrow and my Cardiologist has advised I be started on Apixiban 5mg x2 daily. I have lost weight and feel my muscle tone and skin elasticity is much poorer.
I wanted to take Organic Pumpkin Seed Protein Powder (water for health.com)to combat this would it be safe to take this with Apixiban ?
Thank you in advance.
Your website is a Godsend for people with heart problems xx
It is unknown if pumpkin seed protein powder will interact with Eliquis. However, in general, it would be best to avoid all herbal supplements while taking prescription medications. There are no herbal supplements with clear evidence of benefit, although certain herbal supplements may have limited evidence of benefit. You can read more about herbal medications in cardiovascular medicine here: https://www.ncbi.nlm.nih.gov/pubmed/28254182. It sounds like Eliquis may be a good option for you, and you should discuss any and all herbal supplements with the physician who manages your prescription medications. Thank you very much for the kind words!
Hi Dr. Guichard,
I’m a 32 year old woman with hypothyroidism, atypical migraines, and a history of DVT and PE from pregnancy three years ago. I have no known clotting factors (I was tested for everything except APS). A year after my PE, I had pain in my leg and an ultrasound showed what may be a “continuous” spot of coagulation in my femoral vein, collateral veins, and the vein was almost totally occluded. I’m not sure if that is where the original clot came from, but I suspect it is. I’m on anticoagulants for life, but having a hard time with Coumadin. I am vegan and have bad acid reflux issues, I also avoid grains (they sometimes give me stomach aches), and having to limit my greens is tough! My INR has been wild the past year, going up from a Thai food dish, or too much sunlight, or green tea… Things I never thought I’d have to avoid.
I’m considering switching to Eliquis – though there is no reversal agent, I’ve read that it causes less spontaneous bleeding overall, and that if you have an interracial hemorrhage on Coumadin you only have a 50/50 chance of survival, even when vitamin K is administered. Is this true? I’m hesitant, any advice you have would be so appreciated!
From the information you have provided, it sounds like Eliquis may be a good option for you. Intracranial hemorrhage (ICH) can vary by size and location, both of which are important for prognostication. However, the majority of severe ICHs while also on an anticoagulant are indeed deadly. Warfarin does not have a true rapid reversal agent, vitamin K takes hours to days to work and fresh frozen plasma (FFP) is not an ideal for a number of reasons. Currently, the only anticoagulant that has an FDA-approved rapid reversal agent is Pradaxa (dabigatran) – which is Praxbind (idarucizumab). The other novel anticoagulants will in the near future have rapid reversal agents.
Hello Dr Guichard.
I had 3 TIA’s from a carotid thrombus, that has since been stented. Blood work revealed I have Lupus Anticoagulant. My Neurologist and Hemotologist want me to start Coumadin after I finish 6 weeks of Plavix. There are many, many reasons I don’t want to take it. Is Eliquis an option for me?
Thank you.
I completely understand your desire for a treatment option other than warfarin. Unfortunately, Eliquis is not FDA-approved for that indication.
I have Rhumatoid and osteo arthritis and am taken tramadol and ibuprofen for pain. 2weeks ago I had a bad chest infection my pulse went to 179 I ended up in hospital had scans for blood clots. And x rays and a lot of blood tests. IV been put on apixaban twice a day can you tell me is it safe to take tramadol I know ibuprofen is out I’m worried about this as the pain can be bad. And paracetamol is no strong enough please can you let me know what pain killers are safe with apixaban. Mary
Narcotic pain medications should be fine with Eliquis, but as you mentioned, nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided.
Dr. Guichard
I am a 65 y.o. who has been taking Coumadin for 32 years for a Protein C deficiency, which was diagnosed subsequent to a DVT/PE. Have had very few venous clotting complications over the years. I have had a heart murmur many years and was finally diagnosed with HOCM in 2004 and subsequently developed Afib in 2009. A single cardioversion kept me in nsr until 2015 at which time I had an ablation (pulmonary vein isolation). Went into flutter in early 2017 which responded to cardioversion. I am scheduled for a repeat ablation in May 2017. A recent CT scan revealed significant coronary calcification. I have come to understand this is a side effect of a Warfarin induced Vitamin K deficiency, which blocks activation of the matrix GLA protein, an inhibitor of vascular calcification. I found that the Rotterdam Study also concluded that Vitamin K2 was important for coronary heart disease prevention. As such, I would like to switch to an anticoagulant that is not a vitamin K antagonist and wanted to know what you thought about my transitioning to Eliquis, given my history of HOCM, Protein C deficiency and Afib/flutter. If affirmative, would you recommend waiting until after the ablation to transition to Eliquis. Thank you so much for your advice.
Without knowing additional details of your medical history, from what you describe, you need lifelong anticoagulation for DVT/PTE and AFib/AFlutter. Eliquis would be a reasonable option for you for those indications, and I would discuss this further with your physician. Starting the Eliquis now or waiting until after your ablation doesn’t really matter and I would leave this to the discretion of your physician. Additionally, for your presumed coronary artery disease based on your significant coronary artery calcification score you should be on aspirin 81mg everyday and high-intensity statin therapy.
Dear Dr Guichard. A week ago I was diagnosed with Paroxysmal atrial fibrillation and prescribed 200mg Amiodarone and twice 5mg Eliquis. Although I feel healthwise fine for a 77year old female, my medical records show benign hypertensive heart disease w/o congestive heart failure, peripheral artery disease, right iliac artery stenosis, and carotid stenosis (asymptomatic, bilateral). I am very much afraid of taking the prescribed medications and have postponed their intake since days. The side effects seem to be so great… Please help. Thank you for your expert opinion!
Your CHA₂DS₂-VASc Score for AFib stroke risk is 5 points, which is a stroke risk of 7.2% per year. A score 2 or greater is moderate-to-high risk (in your case, a score of 5 is very high risk) and should be an anticoagulation. You should absolutely take the Eliquis 5mg twice a day, if that was prescribed by your physician. The amiodarone is less important and mainly centered around the management of your AFib, either a “rhythm-control” strategy or “rate-control” strategy. Amiodarone implies a rhythm-control strategy, but a rate-control strategy (i.e. not necessarily using amiodarone) given your age and your underlying medical conditions would be perfectly acceptable in your case. I would discuss the use of amiodarone, or an alternative, with your physician.
Dear Dr Guichard. I thank you so much for your answer, although it made me feel more vulnerable to get a stroke given that my score is 5. May I ask you how you calculated my CHA2DS2-VASc for a AFib stroke? To have a score of 5, does that mean that I am about 50% prone to have a stroke if I am not on an anticoagulant such as Eliquis? —- Again, thank you for taking the time to answer and for your help. Beatrice Villiger
There are online calculators that we use to determine a CHA2DS2-VASc Score, you can find them using any internet search engine. A CHA₂DS₂-VASc Score of 5 is a stroke risk of ~7.2% per year, meaning a ~7.2% chance of having a stroke in 1 year without anticoagulation, compared to ~1.3% per year with Eliquis based on the ARISTOTLE clinical trial. This is a fairly significant difference, in favor of anticoagulation, which is why we recommend anticoagulation for people in your situation.
Dear Dr Guichard. Again, thank you for your prompt and helpful answer. I hope that with today’s question, I can finally “leave you in peace”. Taking now twice 5mg Eliquis, I would like to have your expert advice what has to be done in an emergency when Eliquis is a danger of bleeding possibly to death. Does an anti coagulation antidote exist in such cases? If not, would it be advisable to change to a different coagulant such as Pradaxa? With my very best regards Beatrice Villiger
In the future, andexanet alfa and four-factor prothrombin complex concentrate (4F-PCC or Kcentra) may have potential for reversing the bleeding effects of Eliquis in cases of acute bleeding or prior to emergency surgery. If bleeding is a major issue for you, then Pradaxa is the only NOAC with an FDA-approved antidote.
I had a bone marrow transplant in July 2015. Due to Sepsis 5 months before the transplant I laid in bed for a few months and got a clot in my leg. I’ve been on Eliquis for 18 months. In October 2016′ we tried to get me off it, but I got another clot within in a week so I’m back on the full dose. I have a lot of bruising on my hands and arms in the last six months. Now we’re talking about cutting my dose to 5 MG a day instead of 10. What do you think? Thanks.
That is a tough question. Lowering the dose of Eliquis may reduce your bruising, however, it may not protect you from blood clots unless you meet criteria for the lower dose of Eliquis. The reduced dosing, Eliquis 2.5 mg twice daily, is the recommended dose for patients with at least 2 of the following: age ≥80 years, body weight ≤60 kg, serum creatinine ≥1.5 mg/dL. You could try switching to a different NOAC (i.e. Pradaxa (dabigatran) or Xarelto (rivaroxaban)) or warfarin, to see if your bruising might improve on a different anticoagulant.
I had a blood clot the entire length of my leg in my saphenous vein and also have prothrombin 20210 mutation. I have been on warfarin therapy for over 7 years since the clot. I monitor my levels with an at-home device and call my results in to my doctor to adjust dosage. Would Eliquis be an alternative to use with this mutation? Thanks.
Yes, Eliquis could be a good option for you. In the AMPLIFY Trial (https://www.ncbi.nlm.nih.gov/pubmed/23808982), the only exclusion criteria were contraindications for enoxaparin or warfarin, active bleeding or high risk for serious bleeding, short life expectancy, uncontrolled high blood pressure, and significantly impaired kidney or liver function. Meaning, people with known or unknown gene mutations were included in the trial. You should discuss further with your physician and make an informed decision together.
Air travel related dvt 2015 six weeks injections with clexane.
Ten years later spinal op. Six weeks after that bilateral pulmonary embolisms,
Long term warfarin instituted
Prof has suggested I might prefer elequis
Unsure about side effects as i have ibs and hiatus hernia with nausea often
Should it be ok to change?
Without knowing any additional medical history, it appears that Eliquis could be a good option for you. If your physician made the recommendation, then it would be worth a try if you are unhappy with your current warfarin therapy.
I got diagnosed with paroxysmal afib in November 2016, my heart rate was 170 that day in November 2016 and I was admitted into the hospital, they got me back into sinus rhythm… I was released 2 days later… They prescribed me plaice and atenolol..that didn’t work and I had another afib episode the next month in December 2016 and was hospitalized again this time for 3 days.. Once again they got me back into sinus rhythm.. They released me and changed my meds to amiodarone and eliquis and 81 mg aspirin.. My EP and cardiologist just recently took me off amiodarone and the aspirin and I am now on multaq and eliquis…I am a 38 year old white male, 5’9 inches tall, weigh 180 pounds.. Do you have any thoughts on the information I have given you?
Eliquis seems appropriate in your situation, based on the information you provided. With regards to the amiodarone and Multaq (dronedarone), there are several antiarrhythmic agents that we use to keep people in a normal rhythm. In relatively normal, healthy people we tend not to use amiodarone or Multaq – in fact, we rarely use Multaq at all. Some of the more common antiarrhythmic agents used for AFib in people with structurally normal hearts are flecainide, propafenone, sotalol, and dofetilide. However, in your situation with recurrent symptomatic AFib while on an antiarrhythmic agent, an AFib ablation procedure would be very reasonable.
Above I meant plavix not plaice sorry
My EP and cardiologist wanna see how I do on the multaq before going ahead with an ablation… My EP told me he wanted to see if my afib acts up on the multaq in between now and my next appointment with him in a couple of months…but I’m not really trying to see if it will act up because it put me in the hospital twice and both were scary episodes.. He didn’t give me a heart monitor to wear either in between now and my next appointment either… And my EP kinda worried me when he told me he had to read to tell me how to switch from amiodarone to multaq safely.. That made me a little nervous because I mean hell I coulda read that myself.. I was on amiodarone for 4 months.. December 2016 to April 12th 2017, I know I needed to come off of it though because of the high toxicity levels of amiodarone but I also read multaq is only half as effective as amiodarone is that true?
It sounds like your electrophysiologist has a plan. There are differing practice patterns around the country with regards to AFib management, we generally don’t use Multaq. I would agree that if you continue to have episodes of AFib, then an AFib ablation procedure would be reasonable.
Hi Dr.
I am 54 yrs old and a 2 time DVT patient in my right leg about 10 yrs ago and last time 2015, with two blood clots 1 below my knee and 1 calf both times. So I will be on a blood thinner rest of my life. warfarin has worked for me for the most part, but as you have said when sick, or diet change it can make it weekly blood draws until leveled consistently back out. 1st question is how comfortable should you be not knowing where your INR level is monthly on one of the newer blood thinners? Obviously being a Coumadin user and getting poked once a month or more depending stinks! But you know where your at. with the others it’s like blind faith knowing what your reading is. Can you still get it checked even every 2-3 months even just for piece of mind? 2nd question is I know you can’t tell me what to take, but if you had blood clot history and was taking the rest of your life, what are you putting yourself on? Thank you Dr Guichard
Hi Dr.
I am 54 yrs old and a 2 time DVT patient in my right leg about 10 yrs ago and last time 2015, with two blood clots 1 below my knee and 1 calf both times. So I will be on a blood thinner rest of my life. warfarin has worked for me for the most part, but as you have said when sick, or diet change it can make it a weekly blood draws until leveled out consistently. 1st question is how comfortable should I be never knowing where my INR level is on a new blood thinner. Obviously being a Coumadin user and getting poked once a month or more truely stinks! But you know where your at. with other blood thinner it’s hard leaving to blind faith never knowing what your reading is. Can you still get it checked even every 2-3 months ? even just for piece of mind? 2nd question is I know you can’t tell me what to take, but if you had blood clot history and was taking the rest of your life, what are you putting yourself on? Thank you Dr Guichard
You ask very good questions. You should be very comfortable with the new blood thinners, as a group, they have been proven to be very effective anticoagulants. To date, there is no definitive way to monitor their medication levels or blood “thinness.” If you take each of the medication as prescribed, then you should be adequately anticoagulated. If I had to choose a lifelong anticoagulant, from the currently available options, I would choose Eliquis for the reasons outlined and discussed in my post.
Is Elquis ok for Factor V Leiden. I had a major ‘DVT’ as well as other clots. I have been on Warfarin for 15 yrs. At 10mg a day. I was off Warfarin briefly and had a clot in my carotid artery. Is Eliguis approved for Factor V Leiden?
In the AMPLIFY Trial (https://www.ncbi.nlm.nih.gov/pubmed/23808982), the only exclusion criteria were contraindications for enoxaparin or warfarin, active bleeding or high risk for serious bleeding, short life expectancy, uncontrolled high blood pressure, and significantly impaired kidney or liver function. Meaning, people with known or unknown gene mutations were included in the trial. Eliquis could be a good option, but you should discuss further with your physician and make an informed decision together.
What do people do if they can’t afford eliquis. They told me I woul have to pay $570. For 3 months supply. On Medicare and part d silverscript. So Dr. Prescribed warfarin?
Yes, cost can be a real problem. There is a Bristol-Myers Squibb Patient Assistance Program that might be able to help, you can contact 1-800-736-0003 or visit http://www.bmspaf.org for more information. Additionally, your prescribing physician might be able to provide information about other assistance programs.
I had a blood clot in my leg for no apparent reason. Then 5 years later, while pregnant I got another clot in my leg, after delivery I got a clot in each lung. I was treated for 6 months and then taken off blood thinners. It was 30 years later I got a clot in each lung again. No apparent reason. My doctor had my blood tested with the results showing there was no reason why I was clotting. I was put on Coumadin for life. I have been on Coumadin for 14 years. Because of the food restrictions / testing. I have been looking into changing to Eliquis. I take Metoprolol for a rapid heart beat. Are there any side effects by switching from one blood thinner to another. I have had no side effects on Coumadin. With Coumadin your levels can change from week to week, how do you know when taking Eliquis that the dose you take is correct. There are no food restrictions on Eliquis, is there any alcohol restrictions? Is there any side effects taking cholesterol medicine, currently taking cholesterol medicine on Coumadin I break out with red spots.
There are no side effects from switching from one blood thinner to another. Currently, there is no available test that accurately measures the exact levels of Eliquis in your blood. Eliquis is working properly if you are taking the medication as prescribed. There are no alcohol restrictions on Eliquis, however, you should only drink a mild-to-moderate amount of alcohol for heart health (i.e. 1/3 to 1 ounces per day). There should not be any side effects with taking a cholesterol medication with Eliquis. Your potential allergic reaction may just be due to the cholesterol medication itself, independent of the blood thinner, and you should discuss that with your physician. Thank you very much for your great questions!
After a chronic lacunar infarct was diagnosed in an MRI undergone by a 42 year old male recently for possible Meniere’s Disease, the patient was placed on pradaxa 150mg X2 a day both for future stroke prevention and in continued treatment for paroxysmal A-Fib (currently person is in normal rhythm, and stroke did not impact speaking/thinking areas of brain, thank God). Since taking pradaxa for almost a month, the patient has had GI issues, including hard stool, and a week ago, severe constipation resulting in ER visit for bowel impaction.
Might Eliquis have a ‘cleaner’ side effect profile (less stomach/GI issues) and be more appropriate in this case?
Thank you in advance.
GI issues are a well-known side effect of Pradaxa, and patients are frequently switched to a different anticoagulant. Any anticoagulant would be appropriate, but Eliquis is usually well tolerated and has minimal side effects.
Hello Dr, I had two pulmonary embolisms in April 2015. Currently I am 45 years old. I had zero symptoms until they happened 4 days apart. I spent one night in the hospital and they started me on Eliquis. The hospital Dr said either one between Eliquis and Xarelto. I didn’t know my current PCP then. I had no other signs of clots or DVT. I have Factor V. I am also a pilot for a major airline. I have been flying for over 20 years and this is the first time I had PEs. This week I have switched over to Xarelto. Due to its once per day dosage. I would like to get off these meds all together. Can aspirin work as well? I don’t drink any alcohol. My current PCP says I need to be on a blood thinner for life because of my job. He also prefers Xarelto with its once a day dosage. A co worker with the same gene takes aspirin only. His hematologist says that’s fine. My hematologist says it isn’t and to remain on blood thinners. Whats your opinion?
Recurrent pulmonary embolism, especially with an underlying hypercoagulable disorder, means that you need to remain on lifelong anticoagulation. Any NOAC would be appropriate for you and given your job demands, the once a day NOAC (e.g. Xarelto or Savaysa), should be just fine for you.
Hi Dr.
I had my first baby via c-section three months ago at 34 years old. Two weeks after my delivery I developed several clots in my right lung. I’m currently taking Eliquis for the last three months. I have experienced lightheadedness and moderate joint pain while taking this “blood thinner”. The emergency room doctor told me I should possibly be on this medication for 6 months, the doctor in the thrombosis clinic said three months. How long would you suggest taking this medication? How will I know the clots are completely gone? What test or scans should I request after treatment? What are the chances of reoccurrence, since my blood clots developed after a c-section (no previous health concerns)?
Thank you!
Marie
The duration of the anticoagulant would depend on your work-up at the time of your blood clot. There are important factors that determine the duration (i.e. provoked versus unprovoked, any identified clotting disorders that you may have, etc.). If you are followed by a specialist in this area, who knows your case, I would defer to their judgment. After treatment for a certain duration, usually 3 months, the blood clots should be resolved. In most cases, repeat imaging is not required. Most women do not have blood clots after pregnancy, so there was something about your case either provoked or unprovoked that caused you to have a blood clot. If your risk of blood clots in the future depends on the underlying circumstances of your initial blood clots, and the physician who knows your case should be able to give you an idea about the risk.
Hello Dr. Guichard,
My 22 year old son was hit by a vehicle while walking from lab class at school. He developed a blood clot in his left leg (the leg that was hit by the car) and it broke off and traveled to his lung. He was on Xarelto for 3 months and there was no change and he felt awful on this medicine test showed another small clot had formed. My son talked to his Dr. about trying another blood thinner so he was given Eliquis. He felt better after being on this medicine for a month and tests showed the original blood clot in his leg and lung had disappeared. However, when He went for another test last week the small one that had recently developed is still there and has grown. The Dr. wants him to try Coumadin now and I am tore to pieces over this. He has no history of blood clots and tests were done to prove that just to be sure. Since lawyers are involved. Please tell me what side effects he will have if any taking three types of blood thinner medicines. What does he need to watch for? Can he still workout/run? Will this harm his heart? Will he have any long term effects?
Recurrent blood clots while on a blood thinner (e.g. Xarelto, Eliquis) would be concerning. It sounds like warfarin would be the next logical step and increasing his therapeutic international normalized ratio (INR) levels above the usual standard of 2.0-3.0. Blood thinners are usually well-tolerated and the most important side effects are bleeding, of course. As far as activity and long term use, these would be questions to ask the physician prescribing the medications as he/she would know the details about his particular case.
Thank You! I truly appreciate your quick response.
82yr male c bilat PE and one thrombus found just above old ankle sprain. Renal and hepatic numbers that would be the envy of men half his age, no smoker, mild hypertension well-controlled c first-level meds. In fib-flutter in ER, now 1st deg HB c occasional PVCs vs aberrant conduction. Neg for MI, atrial thrombus, and occult malignancy. Eliquis waaaay too expensive, had coupon for one free month, 5mg bid.
1) How long is anticoagulation needed?
2) Why not warfarin c home POC INR checks?
3) Compare other NOACs for side effects, cost, ease of use?
4) Do you get any sponsorship from any manufacturer of NOACs?
So, it sounds like you have bilateral PTEs, a DVT, and AFib with no obvious bleeding issues.
1. You will need lifelong anticoagulation.
2. Warfarin would be a reasonable anticoagulant. However, home INR machines can be very expensive and sometimes reliability can be an issue. Coumadin Clinics would be the alternative, if convenient for you.
3. All the NOACs cost about the same, depending on your insurance, and side effects are usually minimal (there is a higher frequency of GI upset with Pradaxa). Regarding ease of use, Xarelto and Savaysa are once a day medications, which may be easier than the twice a day medications (i.e. Pradaxa and Eliquis).
4. I have no disclosures or conflicts of interest.
Thank you for the excellent questions!