Apixaban

[cmjoyce]

Thank you to all who answered my cry for help over my nose bleeds. Ended up having a second cauterization in 2 weeks. I am hoping to get to see my GP who runs the anticoagulation clinic at our practice next week and am trying to gather information so I can be well armed. I am wondering about changing to Apixaban as it seems to cause less bleeding events. I know it does not require constant INR monitoring but do you EVER have an INR test as I am assuming this would read higher than the normal 1. I have a coaguchek so could use. If anyone using Apixaban could tell me of any problems they have encountered it would be most helpful. Anyone with Diabetes using it as I have moderate kidney damage from this and know it can be a factor in choice of drug.

Joyce

[BobD Volunteer]

Hi Joyce. The NOACs of which apixaban is only one do not work in the same way as warfarin so need no regular testing although annual liver and kidney checks are a good idea. Not sure about contra indication re kidney problems so best to ask you doctor about that.

Bob

[Finvola]

Joyce, before it is prescribed you will be given a kidney function test to determine whether 5mg or 2.5mg per dose is appropriate - the lower dose can be prescribed if the test indicates some renal impairment. Thereafter, at least annual monitoring of kidney function is done.

[waterlady]

Hi joyce, I have been on apixaban over a year now, everything is fine, but I was not monitored, I had to ask for a blood test covering anything relevant, kidneys etc. Etc. And I asked for my inr reading, which was 1.9. I just like to know. But this site is brilliant, I am slowly learning, my gp is good, but knows nothing about the drug. Hope this helps a little.

[rosyG]

Your kidney function would be tested before you start Apixaban and there is a lower dose if you have problems- I don't know about the protection at the lower dose- do check with your GP

- I think the lower bleeding rate refers to intra cranial bleeds but do check with your GP

I don't think warfarin has the same problems with impaired kidney function but am not a clinician so do check. if you are self testing it is easier to keep in range so hope you have sorted out the nose bleeds

[Alanwilliam]

Hi Joyce.

Regarding your Diabetes and Apixaban. If you google the NICE recommendations for people with AF and Diabetes you will come across the NICE Appraisal Guidance Document TA275 which recommends that anyone with these two conditions should be prescribed Apixaban as an anticoagulant. The reasoning behind this is that those with Diabetes need to follow a specific dietary regime which is highly compromised by the dietary restrictions of warfarin.

As I suffer from these two conditions, I am currently trying to get Apixaban myself from my GP instead of warfarin and am coming up against very strong resistance. I am being given a run around which is obviously driven by cost. The GP I saw didn't even know anything about the impact of vitamin K on warfarin associated with green vegetables. He is in a position of great trust but doesn't even know the basics of a very common medical issue.

Incidentally, my cardioligist who reviewed my medication recently also wrote to my GP and recommended Apixaban, and yet this is also being resisted and ignored by my local practice.

[Bridges4 in reply to Alanwilliam]

Hi Alan

I am type 2 diabetic and was put on Apixaban 2 months ago after a twelve month battle with the local CCG (Essex) who constantly refused to allow my GP to prescribe. I had the support of my EP, Endocrinologist and the local consultant haematologist. In the end the CCG were FORCED to allow Apixaban as one of the most important NICE guidelines states that patients choice MUST be taken into account. You cannot therefore be refused this drug unless there are clinical reasons for so doing.

Take care

Les

[Alanwilliam in reply to Bridges4]

Les.

Thanks for your reply. Unlike you I am battling with my GP surgery and not the local CCG. I must be concerning them as I have been told my case will be discussed at their next practice meeting on the 17th March. Bear in mind I have already been refused twice by two different GP's in the practice. I have given them factual evidence in writing as to why I am a prime case for Apixaban backed up by both NICE and my cardioligist. In spite of this I am being told that they don't have to follow the recommendations of either of those bodies. They are giving me all sorts of foggy answers but quite clearly cost is the main issue. I understand that the NHS is not a bottomless pit but feel I have a prime clinical need for this drug. Watch this space. Alan

[DavDug in reply to Alanwilliam]

Change your practice?