Helping to prevent stroke caused by non-valvular atrial fibrillation Information booklet IF FOUND, PLEASE RETURN TO: Name Address Phone number
Contents ALERT CARD...2 BOOKLET INFORMATION...3 What is atrial fibrillation?...4 What causes atrial fibrillation?...8 Are there complications associated with atrial fibrillation?...10 What are the symptoms of a stroke?... 12 What helps to lower the risk of stroke with non-valvular atrial fibrillation?...14 How to take ELIQUIS... 17 How long to take ELIQUIS... 19 What should I do if I miss a dose?... 20
What should I do if I take too much ELIQUIS?... 21 Things to be aware of when taking ELIQUIS... 22 Possible side effects...24 Healthy living and atrial fibrillation... 26 RESOURCES... 28 Your health record and health team... 30 Health goals: Blood pressure... 32 Health goals: Total cholesterol... 34 Health goals: Glycated haemoglobin (HbA1c)... 36 Managing all of your medicines... 38 Medicines record... 40
It is important that EVERY HEALTHCARE PROFESSIONAL treating you is aware that you are taking a medicine to help prevent blood clots. PATIENT ALERT CARD PLEASE HAVE YOUR DOCTOR FILL IN THIS CARD AND KEEP IT IN YOUR WALLET. 2
ELIQUIS Information Booklet You have been given this booklet because you have been prescribed ELIQUIS (apixaban) to help reduce your risk of having a stroke due to non-valvular atrial fibrillation. This booklet explains how non-valvular atrial fibrillation can lead to a stroke and how ELIQUIS works to help prevent that from happening. You should also read the Consumer Medicine Information leaflet provided inside your pack of ELIQUIS. 3
AF & STROKE What is atrial fibrillation? Atrial fibrillation is a heart condition in which your heart beats fast and out of rhythm. Many people with atrial fibrillation do not experience any symptoms, although a fast and/ or irregular heartbeat may be felt (some people describe this feeling as palpitations ). Other possible symptoms include: z z z z Tiredness Shortness of breath 4
AF & STROKE Chest pain (angina) Dizziness Atrial fibrillation may occur as separate episodes, lasting from minutes up to days. This is called paroxysmal atrial fibrillation, which simply means in bursts. Atrial fibrillation can also be described as persistent or permanent when the symptoms are continuous. 5
AF & STROKE ATRIUM ATRIUM UPPER CHAMBERS OF HEART
AF & STROKE Atrial fibrillation occurs because the nerves that control your heartbeat are not working properly. This confuses the heart s natural pacemaker so it can no longer control your heart s rhythm. In atrial fibrillation, the upper chambers of your heart don t contract properly, which means that the blood cannot be pumped out as usual. Each chamber is called an atrium, which is where the word atrial comes from. 7
AF & STROKE What causes atrial fibrillation? The exact cause of atrial fibrillation is not fully understood, but the risk increases as you get older and it is more common in people with other heart conditions. For example: high blood pressure thickening/blockage of the blood vessels that supply the heart heart attack heart disease from birth after heart surgery congestive heart failure Note: The above is not a complete list of causes 8
9 AF & STROKE
AF & STROKE Are there complications associated with atrial fibrillation? The main risk associated with atrial fibrillation is stroke. As the blood is not properly pumped away from the heart, it may collect or pool and a clot may develop in the heart. If the clot breaks off from the heart wall and travels to the small blood vessels of the brain, it can block the flow of blood to part of the brain and may cause a stroke. People with atrial fibrillation are more likely to have a stroke compared with people who do not have this condition. 10
4. CLOT BLOCKS BLOOD VESSELS IN THE BRAIN AF & STROKE 3. CLOT TRAVELS TO THE BRAIN 2. CLOT LEAVES HEART 1. CLOT FORMS IN THE HEART 11
AF & STROKE What are the symptoms of a stroke? Strokes can happen suddenly and have immediate and lasting effects. You must act FAST, so here are some simple things to look out for that can help you recognise a stroke. Let your friends and family know what to look out for also. FACE Check their face. Has their mouth drooped? ARMS Can they lift both arms? SPEECH Is their speech slurred? Do they understand you? TIME is critical. If you see any of these signs, call 000 straight away. 12
Facial weakness, arm weakness and difficulty with speech are the most common signs of stroke, but they are not the only signs. Other signs of stroke may include one, or a combination of: weakness, numbness or paralysis of the face, arm or leg on either or both sides of the body difficulty speaking or understanding dizziness, loss of balance or an unexplained fall loss of vision, sudden blurring or decreased vision in one or both eyes headache, usually severe and abrupt in onset or unexplained change in the pattern of headaches difficulty swallowing AF & STROKE The signs of stroke may occur alone or in combination and can last from a few seconds up to 24 hours and then disappear, or they may persist indefinitely. If you experience any of these symptoms, you must seek medical attention immediately. 13
AF & STROKE What helps to lower the risk of stroke with non-valvular atrial fibrillation? Blood thinners help reduce the risk of stoke by preventing blood clots from forming. HEART WITH CLOTS HEART WITHOUT CLOTS 14
There are different types of blood thinners, which act in different ways to help prevent stroke. These are: Anticoagulants: which help to block specific chemical reactions in your body that are responsible for blood clotting. Blocking these reactions means a blood clot takes longer to form and this helps to prevent a stroke. Heparin and warfarin (also called Coumadin or Marevan) are types of anticoagulants. AF & STROKE Anti-platelets: as platelets (very small blood cells) clump together during blood clotting, anti-platelet medicines help to prevent this clumping and thus prevent blood clots. This helps to prevent a stroke. Aspirin is an example of an anti-platelet drug. Blood thinners do not treat the symptoms of atrial fibrillation but, importantly, help to prevent stroke occurring. ELIQUIS is an anticoagulant that can help reduce your risk of having a stroke due to non-valvular atrial fibrillation. 15
ELIQUIS 16
How to take ELIQUIS To ensure that ELIQUIS is working for you, always take ELIQUIS exactly as your doctor has told you. ELIQUIS ELIQUIS must always be taken twice a day. For example, one tablet in the morning and one tablet in the evening. Try to take the tablets at the same time every day. To help you remember, try to fit taking your tablets with a normal routine that happens twice a day. You should also read the Consumer Medicine Information leaflet that came with your pack of ELIQUIS. 17
The usual dose for ELIQUIS is one 5 mg tablet taken twice daily. ELIQUIS You will be prescribed a 2.5 mg tablet taken twice a day if you meet any two of the following: are 80 years or older weigh 60 kilograms or under have reduced kidney function You should swallow the ELIQUIS tablet whole with a glass of water. If you have difficulty swallowing tablets, talk to your doctor. ELIQUIS can be taken with or without food. If necessary, it is possible to remove ELIQUIS tablets from the blister pack so that they can be used in a dose-administration aid. 18
How long to take ELIQUIS The length of treatment with ELIQUIS can vary: most people may need to take it long term. You should always follow your doctor s instructions and continue to take your medication for as long as your doctor has told you to do so. ELIQUIS Do not stop taking your medicine or lower the dosage without checking with your doctor. If you stop taking ELIQUIS suddenly, you may increase the risk of developing a blood clot, which can lead to serious problems such as a stroke if you have atrial fibrillation. 19
What should I do if I miss a dose? ELIQUIS If you miss a dose of ELIQUIS, take the medicine as soon as you remember and then take the next tablet of ELIQUIS at the usual time, then continue as normal. Do not take a double dose to make up for the forgotten tablet. If you are not sure what to do, ask your doctor or pharmacist. Do not run out of ELIQUIS; refill your prescription before you run out. 20
What should I do if I take too much ELIQUIS? Immediately telephone your doctor or the Poisons Information Centre on 13 11 26 for advice, or go to the Accident and Emergency Department at the nearest hospital. Do this even if there are no signs of discomfort or poisoning. ELIQUIS Take the medicine pack with you, even if there are no tablets left. You may need urgent medical attention. Symptoms of an overdose may include bleeding that does not stop. There is currently no antidote for ELIQUIS. 21
Things to be aware of when taking ELIQUIS ELIQUIS Inform your doctor and dentist that you are taking ELIQUIS if you are having any surgical or dental procedures. You may need to reduce or temporarily stop taking ELIQUIS, but only if instructed by your doctor or dentist. Make sure that you tell your doctor or dentist about any other medicines you have bought yourself in the pharmacy and any herbal remedies you may be taking (e.g. St John s Wort). Certain medicines and supplements can interfere with the anticoagulant effects of ELIQUIS, increasing the risk of bleeding or making it less effective. 22
ELIQUIS A list of some medicines that might affect ELIQUIS can be found in the Consumer Medicine Information leaflet inside the pack of ELIQUIS. You should not take ELIQUIS if you are pregnant or breastfeeding, have liver disease or a bleeding disorder. So make sure you tell your doctor if you think this applies to you. 23
Possible side effects Like all medicines, ELIQUIS can cause side effects, although not everybody gets them. ELIQUIS Like other similar medicines (anticoagulants), ELIQUIS may cause bleeding that may potentially be life-threatening and requires immediate medical attention. Tell your doctor or pharmacist about any side effects that you experience, even if they are not listed in the Consumer Medicine Information leaflet or in this booklet. 24
Other common side effects include: Bruising ELIQUIS Blood in the urine (that stains the urine pink or red) Nausea (feeling sick) A list of some possible side effects can be found in the Consumer Medicine Information leaflet inside your pack of ELIQUIS. 25
Healthy living and atrial fibrillation Along with medications, staying healthy will help you manage your atrial fibrillation. Consider the following lifestyle factors and how they may affect you. STAY HEALTHY Diet Eat plenty of fresh fruit and vegetables, and avoid fatty meats and too much processed food to help control your cholesterol levels. Lower your salt intake to help control high blood pressure, another health condition that may contribute to atrial fibrillation. 26
Exercise Regular physical activity not only helps in weight control, but also helps you to maintain a positive outlook. Consult your doctor before you start any new forms of exercise to establish whether it is safe given your physical condition. Stress Atrial fibrillation affects people who are under stress. Manage stress through deep breathing and daily exercise. STAY HEALTHY You can find more tips online at www.eliquis.com.au 27
RESOURCES RESOURCES 28
The following resources provide further useful information and contacts on non-valvular atrial fibrillation and stroke prevention, as well as ways to access support services. Atrial Fibrillation Association www.atrialfibrillation-au.org National Heart Foundation of Australia www.heartfoundation.org.au Health Information Service: 1300 36 27 87 National Stroke Foundation www.strokefoundation.com.au Stroke Line: 1800 STROKE (787 653) RESOURCES You can also visit www.eliquis.com.au for information on ELIQUIS and non-valvular atrial fibrillation. 29
YOUR HEALTH RECORD This section of the booklet will help you keep track of all of your medications, healthcare professional details and general health information. YOUR HEALTH TEAM MY HEALTH RECORD Write the contact details of your healthcare professionals here for an easy to use reference guide. 30
DETAILS NAME AND PHONE NUMBER GP Cardiologist Pharmacist Clinical Nurse Dentist Podiatrist Dietician Haematologist Endocrinologist/ renal doctor Geriatrician Physiotherapist MY HEALTH RECORD 31
HEALTH GOALS BLOOD PRESSURE ASK YOUR DOCTOR TO COMPLETE MY HEALTH RECORD 180 170 160 150 140 130 120 110 100 90 80 70 60 50 month Ideal: 130/80 mmhg 1 2 3 4 5 6 32
THIS CHART AFTER YOUR TEST Your Target: 7 8 9 10 11 12 MY HEALTH RECORD 33
HEALTH GOALS TOTAL CHOLESTEROL ASK YOUR DOCTOR TO COMPLETE Ideal: < 4 mmol/l 10 8 6 4 2 MY HEALTH RECORD 0 month 1 2 3 4 5 6 34
THIS CHART AFTER YOUR TEST Your Target: 7 8 9 10 11 12 MY HEALTH RECORD 35
HEALTH GOALS GLYCATED HAEMOGLOBIN 13 ASK YOUR DOCTOR TO COMPLETE Ideal: 7% or 53 mmol/mol 12 11 10 9 8 7 6 MY HEALTH RECORD 5 month 1 2 3 4 5 6 36
(HbA1c) THIS CHART AFTER YOUR TEST Your Target: 7 8 9 10 11 12 MY HEALTH RECORD 37
MANAGING ALL OF YOUR MEDICINES It s important to manage your medicines properly. 38
The following questions for your doctor, pharmacist or healthcare professional will help you do this: Why do I need to take this medicine? How should my medicine work? When will my medicine start to work? How should I take my medicine? With water or food? When should I take my medicine and for how long? Do I need to avoid any other medicines, foods or drinks when I am taking this medicine? What should I do if I miss a dose? Do I need regular check-ups or tests while taking this medicine? What are the side effects of taking this medicine? What should I do if a side effect occurs? How should I store my medicine? MY HEALTH RECORD 39
MEDICINES RECORD Date when my doctor should review my medicines: NAME OF MEDICINE (active ingredient or brand name) STRENGTH WHAT IS THE MEDICINE FOR? HOW MUCH DO I USE AND WHEN? SPECIAL INSTRUCTIONS OR COMMENTS MY HEALTH RECORD DATE STARTED NAME OF PRESCRIBING DOCTOR 40
Have your doctor list all the medicines you are currently taking, including all prescription medicines, over-the-counter medicines, herbal and natural medicines. Medicines come in many forms including: tablets, liquids, inhalers, drops, patches, creams, suppositories and injections. MY HEALTH RECORD 41
eliquis.com.au Bristol-Myers Squibb Australia Pty Ltd. ABN 33 004 333 322. Level 2, 4 Nexus Court, Mulgrave VIC 3170 Australia. Pfizer Australia Pty Ltd. 38 42 Wharf Road, West Ryde NSW 2114 Australia. Registered trademark. McCann Health 10683158. PP-ELI-AUS-0425. 432AU1700027-01. February 2017.