changing to a NOAC

My husband has had wildly fluctuating INR readings over the past 8 weeks. It is now resting in the doldrums and doesn't show any signs of improvement. He has been AF clear for the past 8 years but for the last few days has had a rapid and irregular heartbeat. We are seeing his GP this pm and I expect he will be transferred to a noac. This will be the second time. He was prescribed Apixaban in April, following an operation under general anaesthetic. He had a bad reaction, i.e. came up in a rash all over his body. he was also having clexane injections and I think the GA plus the Clexane probably precipitated the reaction.

Does anyone have a view as to what the INR level should be before he transfers to a NOAC. I have very little faith in his GP having any awareness.

8 Replies

  • He'll have to have an INR test and depending what it is, he will need to wait a bit before starting a NOAC. My INR was 2.2 and I didn't have long to wait.

    I'm on Rivaroxaban and find it at least a thousand times easier than being on Warfarin. I never got the INR under proper control. It was nearly always wayward.

  • Do really well on Rivaroxaban, except expensive in my country. Was very easy to switch temporarily to warfarin when had ablation and then will switch back in a few weeks.

  • clear guidelines on line for changing from one to the other i take dagibtran without problems

  • When I changed I was advised to wait until my INR was below 2. (to Apixaban) there is info in the leaflet you get with it too. I actually reduced mine with spinach and then Apixaban works swiftly but am not advising you to do this!! Need to follow clinicians' instructions!!

  • Thanks Rellim, we have been told to wait until the INR is below 2 and then start Rivaroxaban, just as you said. He has another checkup on Thursday, so Wednesday night is spinach night.

    My only concern is the gap between. He is in persistent AF and I'm terrified of the stroke risk as the warfarin reduces. He had two strokes 8 years ago, so is clearly susceptible.

  • Yes, keep up the green stuff and get going on the Rivaroxaban asap!

    I was told you still have a bit of protection even when INR drops under 2.

    Good luck!

  • Hi Peddling,

    I'm on warfarin and quite happy on it since I self manage.

    However, regarding your concern about your husband's INR dropping below 2 I can only tell you about my experience. I have also had several TIA's, prior to starting warfarin. Three weeks ago I was scheduled to have a pacemaker implant and was told to stop my warfarin 3 days before. I then received a letter the day before the procedure, re-scheduling me for the following week. I then started my warfarin for 5 days and again stopped it 3 days prior to the PM implant. I was told to start the warfarin the day after and just take my usual dose. It took almost 2 weeks to get back up to 2.5. The EP at the hospital said that I would be ok and not to be concerned.

    If your husband is only to get his INR to 2 or just slightly under before starting the NOAC, then from my experience he should be ok.

    Hope things go well with the new NOAC and no adverse reactions this time.


  • Thanks Walter, that is indeed reassuring. INR to be checked again on Thursday and then, hopefully, onto The NOAC.

    Hope you are feeling the benefits of the pacemaker.

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