Eliquis instead of Coumadin

[cp172]

I had a porcine mitral valve installed in Dec 2020. Prior to this I had bouts of AF. I have had no AF for a year and half. My electrocardiologist has recommended I replace coumadin with Eliquis (Apixaban). He says it has a lower risk of bleeds and strokes. Has anyone else started taking Eliquis? Your thoughts?

Thanks,

Mickey

 

[Superman]

Most here are on warfarin for mechanical aortic valves, so there aren’t many options. Eliquis isn’t approved for that.

I think the words chosen are interesting. I don’t know that Eliquis has lower risk than someone on warfarin with a well managed INR. The key, of course, being well managed.

Eliquis is easier to manage. Just take a pill. Less risk there than poorly managed warfarin. It’s easier to screw up warfarin management.

 

[pellicle]

He says it has a lower risk of bleeds and strokes. Has anyone else started taking Eliquis?

I don't know if its approved in the USA for AF,you'd need to consult a specialist, however from what I've read while its better than poorly managed warfarin its inferior to well managed warfarin.

 

[tom in MO]

I had a porcine mitral valve installed in Dec 2020. Prior to this I had bouts of AF. I have had no AF for a year and half. My electrocardiologist has recommended I replace coumadin with Eliquis (Apixaban). He says it has a lower risk of bleeds and strokes. Has anyone else started taking Eliquis? Your thoughts?

Thanks,

Mickey

I have two friends on Eliquis for AF. No problems.

 

[carolinemc]

I have two friends on Eliquis for AF. No problems.

People with aortic valve cannot take Eliquis.

 

[ATHENS1964]

People with aortic valve cannot take Eliquis.

He has a pig valve and not mechanical

 

[cp172]

I confirmed with cardiologist that Eliquis was ok for me. He believes it to be a better medicine than well managed warfarin. I will transition to Eliquis after my back surgery on March 3rd. I may get to have additional discussions while in the hospital. Hope everyone stays safe. Praying for Ukraine.

 

[elMIguel]

One thing that I don't like about the prospect of taking Eliquis is the twice per day dosing. If I were already taking meds twice per day this wouldn't be a problem but now I take all my med once per day and am done.

 

[gpr100rs]

Eliquis is currently in trial for use with the On X mechanical valve.
PROACT Xa - A Trial to Determine if Participants With an On-X Aortic Valve Can be Maintained Safely on Apixaban - Full Text View - ClinicalTrials.gov

Clinical Trial Update: PROACT Xa Evaluates a Mechanical Valve Replacement Without Warfarin

BREAKING NEWS! The PROACT Xa Clinical Trial Launches to evaluate the On-X mechanical valve replacement without the use of warfarin in the aortic valve position.

www.heart-valve-surgery.com

 

[tom in MO]

I think the study description is worth reading:

There is an unmet clinical need for an alternative to warfarin, such as a direct oral anticoagulant (DOAC), as anticoagulation in participants with an aortic mechanical prosthetic valve. Some participants may be genetically hyper- or hypo-responsive to warfarin, which makes management difficult. Another small group of participants is allergic to warfarin. A much larger group of participants has difficulty maintaining warfarin control due to dietary and drug interactions. Finally, the requirement for routine blood testing makes people reluctant to take warfarin. All of these factors drive younger participants in need of aortic valve replacement (AVR) toward selection of a tissue valve instead of a mechanical valve. Despite multiple studies (randomized, matched and risk adjusted) that show that tissue valves are associated with worse outcomes, younger participants choose this type of valve to avoid warfarin. In addition, multiple clinical studies have shown valve reoperation rates are higher for tissue valves used in these younger participants. Providing an alternative to warfarin anticoagulation may lead younger participants to choose a mechanical valve with greater durability and better clinical outcomes.​

 

[Amy]

Eliquis is currently in trial for use with the On X mechanical valve.
PROACT Xa - A Trial to Determine if Participants With an On-X Aortic Valve Can be Maintained Safely on Apixaban - Full Text View - ClinicalTrials.gov

Clinical Trial Update: PROACT Xa Evaluates a Mechanical Valve Replacement Without Warfarin

BREAKING NEWS! The PROACT Xa Clinical Trial Launches to evaluate the On-X mechanical valve replacement without the use of warfarin in the aortic valve position.

www.heart-valve-surgery.com

That’s the trial my CC surgeon wanted me to be in last year; I was like, “I just want the valve with the best track record in hemodynamics, etc. - I don’t care about helping out with a study.” He hemmed and hawed till finally, the morning of surgery, when the nurse came and asked if I had any questions, I all but grabbed her by the collar and said, “Listen, I want a St Jude! Don’t let him put an On-X in me just so I can be a guinea pig on Eliquis!...”

 

[pellicle]

all but grabbed her by the collar and said, “Listen, I want a St Jude! Don’t let him put an On-X in me just so I can be a guinea pig on Eliquis!...”

That's the spirit

 

[Critter]

I have an Onyx valve and I have no intention to go on Eliquis (apixaban). Elmiguel hit the nail on the head compliance is much better with a drug once a day than twice a day. My INR is 2.1 and that is plenty high enough for the valve. Checking an INR is no big deal to me. I have a machine at home and at the office . Apixaban is a great choice for atrial fibrillation since most of those folks can be managed without issues. Only real problem I see with it is the cost of $600 a month in costs. If you don’t have decent insurance you are screwed. In the US there is no such thing as decent insurance.

 

[ATHENS1964]

In the Greek market Eliquis is not very expensive as you can see in the photo from the official page of the ministry the retail price is 73 euros 5MG X 60 tsb, the insured patient ie each employee or retiree pays 25% participation ie 18.25 euros the box

https://erx.gr/catalog/skevasma/2802989202042/skevasma=ELIQUIS%20F.C.TAB%205MG/TAB%20BTx60%20%CF%83%CE%B5%20Blister%20(PVC/PVDC/alu)

 

[Critter]

Athens that is why I said the US bears the brunt of non-regulated price control. Many people here get meds from Canada and Mexico because price increases can happen and do happen because its written into law that Government insurance plans cannot negotiate the pricing of drugs. I wonder if big Pharma had something to do with that?

 

[pellicle]

the retail price is 73 euros 5MG X 60

Contrast that to warfarin...

 

[cp172]

Well after much discussion with two separate doctors who recommended eliquis I converted two months ago. Both doctors believe eliquis to be a cleaner drug. Their opinion is that eliquis causes less bleeds and does not cause interactions with other drugs like warfarin. It is nice not to worry about foods I eat or have to monitor INR. I am in US and have excellent insurance which is available to anyone over 65. I pay $47 month for 30 day supply. I was ok on warfarin but I trust my doctors to know what is best. We are talking about installing a Watchman in a few years. This way I can avoid blood thinners.

 

[Keithl]

I was asked to do the Eliquis trial and felt it might be a little premature for me. I prefer the better stability of a once a day drug that even if I miss a day the half-life and level in my body does not leave me without protection too quickly. I hate Lovenox as it is a shot twice a day, and while I take meds twice a day, on rare occasion miss one. Really shocked they are not pushing Eliquis as a replacement for Lovenox.

 

[AZATADINE]

Came across this on Reddit. Looks like the trial has been stopped....

Artivion stops mechanical aortic valve clinical trial on the advice of Data and Safety Monitorting Board

Artivion this week announced it stopped a clinical trial of its On-X mechanical aortic valve with apixaban.

www.massdevice.com

 

[pellicle]

Came across this on Reddit. Looks like the trial has been stopped....

Artivion stops mechanical aortic valve clinical trial on the advice of Data and Safety Monitorting Board

Artivion this week announced it stopped a clinical trial of its On-X mechanical aortic valve with apixaban.

www.massdevice.com

wow

from that:

The DSMB found that blood clots occurred more frequently in patients who were receiving apixaban. It determined that continuing the trial was unlikely to achieve the primary endpoint and could expose patients to increased risks. Physicians on the trial are being notified to change patients on apixaban back to warfarin.​

... and this is all being compared to "usual" (meaning borderline incompetent) "care" of less than 79% Time in Therapeutic Range ... time and time again we see this push away from warfarin, but seldom to we see a study using TTR >= 90%

There's a reason for that...