Currently going through similar but different situation. Blood clots in my arm from a PICC line to treat a staph infection. I am 3 days into the switch from the 10 mg to the 5 mg dosage. My arm is about back to normal in the swelling to slight pain department and I make the assumption the clots are assimilating into my system proportionately. The reduction in swelling I'm sure is dependent on size and number of clots, so the answer is going to be the non definitive one the sucks " It depends".
This is round 3 with blood clots and treatment over 15 years.....hip replacement surgeries and bike wreck. If your family doctor can't get you the answers you are looking for, ask him to refer you to a hematologist like I did. Lastly, remember to consider the aspirin content of any NSAIDs you take.

Good luck with this, and yes, this getting old shit is starting to suck

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Rebuilt with twice as many titanium parts as Portland79.

Thanks for the reply. So far one week into this the doctors I have seen do not understand triathletes. They probably do not see many. Family doctor appointment on Thursday will ask recommendations for hematologist. Good luck on your problem

Reviving this thread...

Am on eliquis, hematologist is thinking for rest of life as unclear what provoked it (though blood tests don't show the reason either).

Have you continued to train and race on eliquis? Hematologist is strongly advising me against it (for good reason, no doubt)

Been on coumadin since 2010. I test at home and self dose for a low INR, which I know is not an Eliquis thing

about 11 halfs. 4 fulls. Training for #5 next month. Escape from Alcatraz, SOS. MTB, snowboard, scuba dive, trail run

And yeah my docs would probably prefer I wouldn't

Yeah, reversal agent for Warfarin / Coumadin much more widely available than for Eliquis...

Googling now, seems like availability of reversal agent for Eliquis is a challenge given new drug and price tag ($25k!!).

Maybe Coumadin will be the way to go longer term... Am 5 months in

 no, coumadin is not the way to go anymore provided insurance covers. too variable. Eliquis/xarelto safer with better side effect profile if you need reversal for eliquis or for coumadin you are in the hospital anyways. Reversal is now widely available.

If you have no issues at all then coumadin is cheaper but the above issues persist.

Yeah, that is really the primary reason I haven’t switched to the newer drugs yet

Is the reversal agent for Eliquis widely available (Andexxa)? My hematologist was concerned about it's availability.

She was suggesting to consider Lovenox. Downside are the injections, i guess, maybe...

Let me rephrase. There are several agents that have been out for a few years. The issue is whether hospitals carry it on their formulary given the expense. Hence it's available for hospitals to carry it. When the reversal agents came out it took us a while to carry the agents. I'm in the Cleveland area so it is no longer an issue. Also many trauma centers have it as it's quite important to be able to reverse.

I'm quite afraid of coumadin as I've seen many hemorrhagic strokes from supra therapeutic INRs. IMO anything that lessens this outcome is well worth the costs.

I have been on Coumadin since 2011 after a bunch of blood clots and three pulmonary embolisms, due to an IVC filter being installed after the first DVT and pulmonary embolism, the filter ended up rupturing and caused all sorts of issues. I can understand you being concerned about Coumadin or any blood thinner for that matter, but once you have the dosage dialed in with Coumadin it is quite easy to manage.

I tend to keep it around the 2.0 don't like it going higher too much, it is quite easy to keep it stable and on the lower end of the scale. I did have a nasty bike accident back in 2016 where I was hit by a truck and ended up with a very bad concussion as I hit my head bad, broke the helmet but thankfully no brain bleed, so I was happy about that.

As for the reversal process, during the issues I had back when the IVC filter ruptured my vein collapsed and I needed to have it ballooned out 4 times, one time I was in UCLA and they wanted to give me a blood transfusion to help with the reversal process and I said no way knowing my luck at that time, so I was able to wait until the next day before they did the surgery as my INR went below the 2.0 range thankfully. It's not quite so simply from my understanding the reversal process and after speaking with the hematologist he said a lot of times they prefer to give blood transfusions to help out, something I wouldn't want especially if you can wait for the surgery.

I have been asked to go on to some of the other blood thinners but my main concern is there is no actual control or measurements with them so what might be good for one person may be too much for another etc. I like knowing my therapeutic range on Coumadin unlike any of the other drugs, but everyone is different and it's their choice at the end of the day.

Thanks. Appreciate it.

You seem knowledgeable on the subject so let me ask two follow-ups:

Thoughts on the efficacy of pradaxa (vs Eliquis)? From my basis googling, seemed quite comparable
Thoughts on availability of the reversal agent Praxbind (for Pradaxa) vs Andexxa (for Eliquis)? Price seemed to be 1/10 and was approved 4 years earlier so presumably more widely available...?

BTW, I am based 25 miles north of NYC (lower Westchester county) so quite populated with many big and reputable hospitals in the area.

Thanks again

You had a terrible experience. Sorry to hear about that. You are absolutely correct in that if you are stable then it's quite easy to stay therapeutic. Statistically though with a larger sample size this does not hold true and there is a higher incidence of complications eg major and minor bleeding.

Reversal is straightforward:
Coumadin = vitamin k if you can wait it out or fresh frozen plasma if it's more severe eg bleeding, low BP

Direct oral AC (DOAC) = Praxibind, Andexxa, etc

As you stated, the decision to receive blood products is harder to accept. Though if you are bleeding to death, it's a lot easier to live with the choice. Impressive and lucky that you did so well despite such a terrible complication.

@ejd_mil - oral direct thrombin inhibitor (dabigatran) is similar to direct factor Xa inhibitors (xarelto, eliquis) Not sure why dabigatran never took hold at least in my areas (might be d/t marketing) but IME eliquis and xarelto are the clear winners (at least as it pertains to DVT/PE, and probably a fib). I seem to see Pradaxa used more in cardiology areas. Hopefully someone can chime in on this.

I've been on Eliquis for over a year due to an unprovoked DVT. Initially I was on 10mg/2x day for 7days then 5mg/2x day for 3 months. I'm currently on 2.5mg/2x day dose which I will likely maintain for life (I'm 51). I started training (swim/bike/run) after ~1 month and have had no adverse effects. I'm back to IM training level and did a 70.3 in July (1 year after the DVT) with a good finish time close to my PR. I have a 2nd 70.3 this month and am planning an IM in October. I stop Eliquis 2 days prior to races in case I have a crash so there isn't a clotting issue and then re-start post the race. So it is working fine for me. Good Luck for your situation.

This is an old thread so I will update I was only on Eliguis for 6 months then taken off. Been several years now

I'll share what I was told by my hematologist. I am not a medical professional, just repeating what I was told and can't vouch for the accuracy.

Past history, DVT and subsequent PE, unprovoked, treated with Xarelto 6 mo, followed by superficial clotting which was treated for another year on Pradaxa.

My hematologist at the time steered me to Pradaxa for the longer term therapy given cycling as a preferred exercise. The differentiator for Pradaxa being that in a severe/catastrophic bleed your body's clotting factors can overwhelm the drug and still clot to some extent when you really really need it.

FWIW - Pradaxa was a pain because it is dosed 2x/day and pills are individually packaged (don't come in a bottle). I also suffered pretty bad heartburn from it at the start of therapy. Xarelto never had any side effects for me.

I see asimilar trend here (Finland). Rivaroxaban (Xarelto) is used due to being administered once a day, but apixaban Eliquis seems to be the most popular. Why this is I'm not sure. Edoxaban (Lixiana) was late to the game and I rarely see it used. There seems to be some sort of consensus that DOAC taken twice a day cause slightly less adverse haemorrhaging, but there are no direct comparision studies that I know of.

Dabigatran is interesting. At least in theory the antidote is a lot more effective than the ones used for warfarin and Xa inhibitors. Here it is available in most hospitals. It is expensive, which might be a concern in the US. One issue with dabigatran is that the guidlines suggest it has to be started after 5 days of Iow-molecular-weight heparin when treating DE and DVT. In the hospital it's no issue, but few patients stay in the hospital that long. Due to the apparent effectiveness of the antidote I'm surprised so few athIetes seem to be using it.

I’m a pharmacist, you can get Pradaxa in a bottle. However, it does need to be kept in the original bottle.

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Let food be thy medicine...