Dr. Wants Me To Take Eliquis & I Have a Bioprothesis Aortic Valve?

[itsme2]

Eliquis literature states:"Eliquis is not for patients with a artificial mechanical or bioprothesis heart valve." Is my doctor wrong about prescribing Eliquis for Afib?

Thank you.

 

[pellicle]

Dunno, their site suggests:


ELIQUIS (apixaban) is not for patients with artificial heart valves.

However it is unclear if they differentiate bioprosthesis from mechanical prosthesis ... Myself I would not want anyone I cared about on those drugs.

Further:
http://circ.ahajournals.org/content/...14807.abstract

emphasis mine

There was no evidence of a differential effect of apixaban over warfarin in patientswith and without valvular heart disease in reducing stroke and systemic embolism (...),
causing less major bleeding (...),
and reducing mortality ().

so basically aside from not needing to monitor your INR its a non event.

You write that you have a bioprosthesis, so why are you on Eliquis anyway?

 

[dornole]

Doesn't it say right on the TV commercials with the insanely cheerful patients that it's not for patients with a heart valve problem? I mean, if the drug co says no and rules out a whole market where they can make money, there must be a powerful reason.

For what it's worth I still have my native valve but am on 325mg full dose aspirin after my repair.

 

[epstns]

I would think that this requires some clarification - from someone with direct knowledge of the reason for their recommendations.

They could mean that Eliquis is not meant to be a substitute for warfarin in patients taking that warfarin due to their need for ACT as a result of replacement heart valves. If a patient has a bioprosthetic valve and only needs ACT due to afib, then it might be appropriate to use Eliquis. This patient is not using Eliquis to manage their prosthetic valve, but they are using it to manage their afib, which is an independent condition.

I'm not a doctor - just a patient. I would like to hear from someone who has the technical credentials to clarify the situation, though, as I occasionally have afib, and I have a tissue prosthetic valve. Who knows what my future holds?

 

[pellicle]

Hi

woe ...

Doesn't it say right on the TV commercials with the insanely cheerful patients that it's not for patients with a heart valve problem?

you mean there's ads for this stuff on TV? ... Really?

I would think that this requires some clarification

and a big Amen to that Brother Steve ... If it was me itsme2 I'd be seeking clarification from your Dr as to why you are on that?

 

[rnff2]

@ Pellicle

Yep, commercial ads all day everyday on TV. I feel like I can't forget about my valve for a second because there is always a commercial saying "not for use for those with artificial heart valves."

 

[pellicle]

Yep, commercial ads all day everyday on TV. I feel like I can't forget about my valve for a second because there is always a commercial saying "not for use for those with artificial heart valves."

I am reminded why I don't have TV
happily such ads are illegal in Australia

 

[epstns]

@ Pellicle

Yep, commercial ads all day everyday on TV. I feel like I can't forget about my valve for a second because there is always a commercial saying "not for use for those with artificial heart valves."

I "think" that what they mean is that Eilquis is not meant as a replacement for warfarin therapy for those requiring anti-coagulation therapy due to prosthetic heart valves, which patients are primarily those with mechanical valves. I also "think" that they mean that if a patient needs anti-coagulation therapy for another reason, such as afib, that Eliquis is appropriate even if they have a tissue heart valve implant. But I'm only making educated guesses at this point.

I also think (no quotes, this time) that if I come to need anti-coagulation therapy for afib in some future time, I would still use warfarin. It may take some care in its management, but at least it is reversible in case of emergency.

 

[rnff2]

I "think" that what they mean is that Eilquis is not meant as a replacement for warfarin therapy for those requiring anti-coagulation therapy due to prosthetic heart valves, which patients are primarily those with mechanical valves. I also "think" that they mean that if a patient needs anti-coagulation therapy for another reason, such as afib, that Eliquis is appropriate even if they have a tissue heart valve implant. But I'm only making educated guesses at this point.

I also think (no quotes, this time) that if I come to need anti-coagulation therapy for afib in some future time, I would still use warfarin. It may take some care in its management, but at least it is reversible in case of emergency.

I think I have to agree with you. Although I do remember having a conversation with a drug representative about the anticoagulant they were educating us on, sorry I don't remember which one, I asked if heart valve patients could use this anticoagulant and I was told no. I didn't specify what type of heart valve and I didn't get a full explanation as to why. So I wonder...what to think. I apologize for not remembering specifics.

BTW...epstns, Dr. McCarthy did my surgery also. He even used the ring he designed to repair my tricuspid valve in addition to replacing my mitral valve.

 

[Protimenow]

The drug companies make a lot of money with these new drugs. That's why they advertise so damned much. Interestingly (maybe even coincidentally), ambulance chasers have commercials right after the Eliquis commercial that target people who've been injured by Pradaxa - another heavily marketed replacement for warfarin. Actually they say 'if you have been injured or a loved one has died....'

Warfarin costs maybe a dime a pill. It's available as a generic. Drug companies aren't raking in the fortunes that they do with these other drugs. These effects of these other drugs aren't always easily reversed.

I don't have afib. I have a prosthetic valve. I take warfarin. If I take too much, the effects can be easily reversed. I have my own meter(s) and monitor my INR. Managing my anticoagulation with warfarin isn't that big a deal.

Even if I didn't have a prosthetic valve, but only had Afib, I still would probably stay away with these new medications and stay with warfarin - a medication with a long history, lots of documentation on its management (and reversal), and low cost.