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Can Eliquis Be Taken For Atrial Fibrillation?
Question: Hi. I'm a 67 year old male, with family history of heart disease. I currently take Lipitor for cholesterol which keeps the total around 150. I have been diagnosed with moderate coronary artery disease. Heart XXXXXXX 7 years ago showed 40 to 50% blockage in the main artery. Ultrasound recently showed 70% blockage in carotid. The only possible coronary symptom that I have is occasional dizziness on standing. I was also diagnosed with A-fib about 15 years ago. I am taking Flecannide for this and it is relatively well controlled. I go out of rhythm only about 2-3 times a year and convert back after a couple of hours with some extra Fecannide. I have been taking one adult aspirin daily for several years. My doctor believes I should stop the aspirin and start Eliquis. I'm very active, in good physical condition with low BP and pulse. BMI around 21. I realize that the CHA2D2S??? thingy suggest that I be on a blood thinner. However, I am concerned that due to my activity level (occasionally I fall during sports competition) and the infrequent episodes of A-fib that Eliquis may not offer the right risk / benefit profile. What do you think?
Brief Answer:
I strongly encourage to start on anti-coagulation.
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern, and I would like to explain that based on your medical history (coronary and carotid vascular disease, and your age between 65-74 years old) you are considered of being at "moderate-high" risk for stroke/TIA/systemic embolism (2 points) and are recommended being on regular anti-coagulation.
I agree with your doctor on that point, and would suggest you to consider starting a new oral anticoagulant (such as apixaban [Eliquis] or others as well, because they offer a more stable anticoagulation; without any need to check frequently INR (prothrombin time), thus avoiding the risk of bleeding).
From my point of view, I would recommend avoiding competitive sports (which may be a source of traumatic injuries) and engage in more secure sports like swimming, running, aerobics, yoga, etc.
So, it depend on you the possibility to modulate the risk/benefit profile, getting the best from this recent therapy.
Remember that, it is better to pay sufficient attention to such an important issue (potential cardioembolic/systemic event), than to suffer the consequences of a poor prevention.
Nevertheless, it will depend on your joint decision (you and your attending cardiologist), to decide the most appropriate strategy you could follow.
My personal opinion would be a strong encouragement to start on anti-coagulation.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
I strongly encourage to start on anti-coagulation.
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern, and I would like to explain that based on your medical history (coronary and carotid vascular disease, and your age between 65-74 years old) you are considered of being at "moderate-high" risk for stroke/TIA/systemic embolism (2 points) and are recommended being on regular anti-coagulation.
I agree with your doctor on that point, and would suggest you to consider starting a new oral anticoagulant (such as apixaban [Eliquis] or others as well, because they offer a more stable anticoagulation; without any need to check frequently INR (prothrombin time), thus avoiding the risk of bleeding).
From my point of view, I would recommend avoiding competitive sports (which may be a source of traumatic injuries) and engage in more secure sports like swimming, running, aerobics, yoga, etc.
So, it depend on you the possibility to modulate the risk/benefit profile, getting the best from this recent therapy.
Remember that, it is better to pay sufficient attention to such an important issue (potential cardioembolic/systemic event), than to suffer the consequences of a poor prevention.
Nevertheless, it will depend on your joint decision (you and your attending cardiologist), to decide the most appropriate strategy you could follow.
My personal opinion would be a strong encouragement to start on anti-coagulation.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello. Thanks for your speedy reply.
Your answer certainly seems logical and was somewhat expected.
In reference to my moderate to high risk for stroke profile,
I have concerns to what seems like a "one size fits all" approach to recommending medication. First, I'm out of rhythm for perhaps 3 hours a year, but I have an a-fib diagnosis and I'm considered to be at the same risk as another person who may be out of rhythm for hundreds of hours a year or even perpetually.
Next, my vascular disease is considered moderate, yet I'm considered at the same risk as another person who may have 90% blockages and or a history of bypass or carotid surgery, etc.
Do these differences in degree just not matter?
Your answer certainly seems logical and was somewhat expected.
In reference to my moderate to high risk for stroke profile,
I have concerns to what seems like a "one size fits all" approach to recommending medication. First, I'm out of rhythm for perhaps 3 hours a year, but I have an a-fib diagnosis and I'm considered to be at the same risk as another person who may be out of rhythm for hundreds of hours a year or even perpetually.
Next, my vascular disease is considered moderate, yet I'm considered at the same risk as another person who may have 90% blockages and or a history of bypass or carotid surgery, etc.
Do these differences in degree just not matter?
Brief Answer:
Prevention is much better than treatment.
Detailed Answer:
Hi again!
I would like to explain that 3 hours a year is quite a prolonged time to allow cardio-embolic events to happen.
Even a couple of seconds in paroxysmal atrial fibrillation is sufficient to produce dangerous embolic complications, especially in predisposed individual like you (CHA2DS2 vasc score).
Your coronary heart disease is considered moderate, without clinical significance 7 years ago, but quite a pretty much time has elapsed from then, and the atherosclerotic process has evolved, aggravating the degree of coronary stenoses; thus leading to clinically important ischemic implications in the near future.
So, it is necessary to prevent thrombotic complications of those intravascular plaques.
That’s why you need anticoagulation.
Meanwhile, you need to investigate possible cardiac ischemia by different imagine cardiac stress tests, even by repeating coronary angiography.
When it comes to prevent disastrous health complications, the benefits/risks ratio will almost always result favorable, facing the other side of the coin (when complications has already happened and nothing could change this reality).
I wish you a good health!
Regards,
Dr.Iliri
Prevention is much better than treatment.
Detailed Answer:
Hi again!
I would like to explain that 3 hours a year is quite a prolonged time to allow cardio-embolic events to happen.
Even a couple of seconds in paroxysmal atrial fibrillation is sufficient to produce dangerous embolic complications, especially in predisposed individual like you (CHA2DS2 vasc score).
Your coronary heart disease is considered moderate, without clinical significance 7 years ago, but quite a pretty much time has elapsed from then, and the atherosclerotic process has evolved, aggravating the degree of coronary stenoses; thus leading to clinically important ischemic implications in the near future.
So, it is necessary to prevent thrombotic complications of those intravascular plaques.
That’s why you need anticoagulation.
Meanwhile, you need to investigate possible cardiac ischemia by different imagine cardiac stress tests, even by repeating coronary angiography.
When it comes to prevent disastrous health complications, the benefits/risks ratio will almost always result favorable, facing the other side of the coin (when complications has already happened and nothing could change this reality).
I wish you a good health!
Regards,
Dr.Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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