I was interested in switching to this before my ablation also. However the doc wanted to keep me on Pradaxa since I was on it already.

The goal of the ablation is to be off everything. So hopefully after your ablation and about 6 mos, you won't have to worry about it anymore! (:

My EP moved me from pradaxa to Xarelto two weeks before my ablation, he would have preferred warifin, for some reason he does not like the pradaxa, I was glad to get off it because of the severe gerd it caused. Had a reaction to xarelto and did not realize it was the xarelto until a month after the ablation and was switched to Eliquis, I immediately felt like a new person,so far so good and no side effects. EP is happy with the Eliquis

Heart222:
I have varicose veins in my legs, and 5 years ago had a DVT that resulted in an entire family of pulmonary embolisms. I spent almost a week in the hospital in addition, I have mild sleep apnea. And, since I've already had one stroke, even though the ablation may remove the eminent threat from my afib, given my cluster of potential clotting issues, I'd feel safer on an anti-coagulant long term.

Paul: Actually, it's not that simple.

Pradaxa is the most effective in reducing strokes (34% less than Coumadin as compared to Eliquis at 21% less and Xarelto 12% less) according to the neutral websites that compare the 3 drugs as measured against Coumadin.

Eliquis had the lowest bleeding rates at -31%, Pradaxa at -7% and Xarelto at +4%.

Pradaxa had the lowest death rates (-12% with Eliquis -11% close behind. Xarelto -8%).

With all that said, the 3 drugs are so close when you realize these %s are not absolutes. If your stoke risk is 1.4%, the %s above don't move the absolute risk that much. Same thing with the bleeds. Further, in the case of Pradaxa and bleeds, most of them were for over 75 year olds with poor renal function. Actually, Coumadin works quite well also. You have to take what works for you. GI problems? No Pradaxa. Renal problems? No Pradaxa. However, for me (for example) I'm not 75 and I have no GI problems, so having the lowest stroke and death rates means the most to me. Even if the bleeds are more with Pradaxa than Eliquis(for the whole universe of people), not having a stroke and not dying are more important.

So anyway, the nice thing about Eliquis is that it is 2nd best (of the new 3 NOACs) in reducing strokes, 2nd best in reducing deaths, and best at avoiding bleeds. So that's a good combination. For that reason, Eliquis seems to be the best choice for people over 75, with GI problems, or with renal function problems.



Comparing the new anticoagulants (cut and paste from a website)


Pradaxa Xarelto Eliquis (P, X, E)

Risk of stroke or embolism (efficacy)
-34% P
-12%* X
-21% E
Risk of death (all-cause mortality)
-12%* P
-8%* X
-11% E

Risk of major bleeds (safety)
-7%* P
+4%* X
-31% E


petey

Oh and Pradaxa is taken twice a day (shortened half life).

Hi Paul,

Petey said With all that said, the 3 drugs are so close when you realize these %s are not absolutes. If your stoke risk is 1.4%, the %s above don't move the absolute risk that much. Same thing with the bleeds. I think that is an important statement. Also, as far as I know, when these drugs were being compared to Coumadin the total time in range was 50 65%. Which means if you are in range more than that, dont mind getting blood tests (or better yet, if you self monitor) Coumadin could be equally as safe as the other drugs. Which means that basically all 4 drugs are close and after taking GI problems, renal function problems and age into consideration, it all comes down to personal preferences.

I take a Coumadin derivative (Marcoumar), self monitor and have been in range for over 96% of the time. I am relatively new to this; started anticoagulation after my TIA on Dec. 1st, finally got into range on Dec. 26th and started to self monitor on January 1st. The two times I was out of range I had a INR of 3.1, which is hardly cause for alarm. I caught it quickly and moved it back into range.

I chose Coumadin because I didnt like the fact that there was no way to stop bleeding in case of an accident not that I plan to have an accident, but then again, I didnt plan to have a-fib or a TIA, so you just never know. Someday I may change to a NOAC, Im leaving that possibility open.

What does your doctor recommend and why?

atp

Acrossthepond; Which self monitoring device do you use, how is it paid for in your country (that's England ?). I asked my cardiologist (who I am not happy with, will probably change after the EP does my ablation). She says the self test units are not actuate. You don't know who to believe.

Petey: Ah, I did some more reading. I didn't realize Pradaxa was twice a day and has a half life of 12-14 hours. However, there have been so many reports here of GI problems with Pradaxa. My GI situation isn't bad, but not perfect either.

Paul, Eliquis is also twice a day......

The last time (my 2nd a-fib) attack I was off the Warfarin and they had put me on Aspirin. The Cardiologist at the hospital put me on Eliquis and it was fine, but shortly after that they put me back on Warfarin. Eliquis is very expensive and my co-pay at Kaiser was $75.00 and they told me within two months it would go to over $300.00. There is no way with me having to quit teaching, that I could afford this and they also said they believed that Warfarin was much safer - easier to stop the bleed if you were in an auto accident, surgery, etc. So I went back to Coumadin..It was nice there for a while not having to be tested. The only thing, I never asked, was without testing with the new co-ag meds. how do you know what your INR is? I wish it wasn't so expensive.
Hugs,
Christine

Just checked with my insurance company.
My Copay for Apixaban is $90.00 for 3 months
Pradaxa and Xarelto are $50.00 for 3 months.
Coumadin 2.5 mg -- $5.46 for 3 months (plus the cost of blood work)

Paul, you have a fine prescription plan. I just refilled my Pradaxa, 3 mos. supply, mail order cost me 144.

You guys need to go online and search for discount cards.coupons.
My Xarelto costs $90 for 3 months but with a discount card it's only $30.

Here's some info for Eliquis
www.eliquis.com/coverage-assistance.aspx

McHale

Paul, makes me wonder how Medicare can get a way with charging me 75.00 for 1 month supply? This is sr Medicare Advantage, too.I should look into this!!!
Christine

I use the Coaguchek XS by Roche to self monitor. It tests capillary blood from your finger.

http://www.coaguchek.com/coaguchek_patient/en/home.html

My doctor uses the Coaguchek XS Plus. Which is the same machine but can save more data but it uses the exact same testing strips that my machine does. We did a parallel test and they had 2.6 and I had 2.5 INR (using strips from two different batches). As long as you are within 10% of the average of the two measurements you are good (no two are exactly alike). The last time I was at the office, they didnt even want to do a parallel measurement.

I live in Switzerland. Health insurance is obligatory here and since July 2011 the CoaguChek is covered by the basic insurance. Your doctor has to inform your insurance company that you need self monitoring of anticoagulation and why, the insurance doctors say okay, then you have to take a course in how to use the machine, how to calculate new dosages and understand the blood thinning process (insurance pays for that, too). The insurance will pay for a new machine every 5 years and pays for about 72 testing strips per year.

That is the only machine in Switzerland that is paid for. I cant imagine a big company like Roche selling a machine to hospitals, doctors and patients that wasnt accurate so I believe they know what they are doing.

Do you go to your cardiologist to have your INR checked? Do they draw blood and send it to a lab to have it checked?

atp

Thanks for the info acrossthepond:

You're going to love this!

Five years ago I had pulmonary embolisms and was on Coumadin for six months (with another doctor), and the whole process was fine. I would go to the lab (about 3 miles from my house) for the blood draw, they would do the INR, call the doctors office the next day, and then the doctors office would call me to change my dosage if necessary. My payment for the draw and test was $3.07 after the insurance discount.

With this post stroke cardiologist, she wanted me to come to her office for the blood draw, charge me and my insurance company for an office visit, and then send the blood to the lab. So I was getting charged a $20.00 copay for the office visit, and still $3.07 for the lab work (and she was getting at least $100 for the blood draw done by the nurse). I let her know felt that was a bit of a scam and insisted on a standing order for INR's at the lab. You just can let them get away with this cr*p.