change from warfarin to apixaban: Hi everyone... - AF Association

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change from warfarin to apixaban

Hi everyone,

Can anyone help me with how they did this?

I took my last warfarin yesterday (Friday) and do not start Apixaban until Monday

I am concerned as my INR today is 1.6 ( Has always been less than 2.0) and worried as to how low it will drop by Monday.

Any thoughts will be greatly appreciated.

Joyce

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If your INR has always been under 2, you have never been in the therapeutic range and so you may not be significantly worse off without Warfarin during the transition. Your INR will probably be about 1 without any warfarin.

I don't remember the details but I had to wait for INR to drop and then start on a NOAC.

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Hi Joyce,

This sorta answers your question and sorta doesn't. I just had a partial knee replacement and had to come off Warfarin. I hope all these figures come out OK.

DATE INR COMMENT

28/10/2015 2.2 Regular Coaguchek INR on my own Coaguchek device

30/10/2015 Took last dose of Warfarin pending surgery - 5mg

daily except Mon and Wed when it was 4 mg. (33 mg

per week)

01/11/2015 2.3

02/11/2015 1.9

03/11/2015 1.4

04/11/2015 1.3

06/11/2015 1.1 Check in for surgery at 07.20 hrs

After surgery, late afternoon was given an injection of

Fragmin in 5000 units

07/11/2015 Another injection of Fragmin in 5000 units

Restarted Warfarin in normal doses ( as at 30 Oct)) at

normal dose time - 8 pm

08/11/2015 1.3

09/11/2015 Discharged from hospital

I have only provided this data up to the point of being discharged from hospital to home. My return to target INR (well, close to it) was reached on 1 Dec 2015 with a reading of 2.4. This may assist you but read it with caution as it is only MY EXPERIENCE ! and I have the good fortune never to have had an issue with Warfarin. The reading of 1.1 is recognised as being normal.

In terms of dates I assume we are talking of Fri 11 Dec to Monday 14 Dec ???

Just a couple of thoughts - did they tell you what INR they expected you to achieve by the Monday. If not how do you know where you are ?

Also, do you self test and get your own INR reading or do you go to a clinic and have it done by either finger prick or venous draw.

My personal opinion as a patient (NOT healthcare professional) is - that it should be around 1.1, but, don't be surprised if it is still only around 1.3 - AND - don't worry either. Do ask and check what target INR you should be at before they switch you to Apixaban.

If you think of it Joyce and have the time I'd be really interested in the outcome and to know what it did actually drop to. Thanks.

Good luck.

John

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Hi John,

Thank you for your very helpful reply.

This was my experience

Friday 11.12 15 took last 5.5mg warfarin. INR was 1.6

Saturday 12.12 15 No warfarin taken INR was 1.6

Sunday 13.12.15 No warfarin taken INR was 1.5

Monday 14.12 15 Ist 2.5mg Apixaban ( 2xdaily) INR was 1.4

Tuesday 15.12.15 2nd INR was 1.2

Wednesday 16.12.15 3rd INR was 1.1

Thursday 17.12.15 4th INR was 1.1

I have my own coagucheck so was no problem to monitor.

The schedule was given me by my GP but he had to look everything up as he said he has not changed anyone from warfarin to Apixaban before although he is in charge of anticoagulation at our surgery. To be honest I already knew more than he did by all the help of this great site.

Thank you for your interest.

Joye

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Hi Joye,

Yes I did get your post. Thanks.

Well it seems that your results came fairly close to mine, given that we all respond differently to medication. Good luck on your journey with Apixaban, hope it works for you.

John

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I don't know if this will help but my heart specialist told me, in all the tests, 1 adult aspirin had the same results as Warfarin. That's 325 mg. I couldn't believe I heard that right so I asked him 3 different times. All three times he said there was no difference in the studies between warfarin and 1 adult asprin. And he said take it in the evening. I've had 2 different procedures for AR and that's the only blood thinner I take.

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I am not medically qualified but you must get a second opinion. If you look up NICE as from June last year aspirin has NO place as an anticoagulation therapy for those with AF. You are not protected against strokes. It is only one of the four NOACs or warfarin that does that. Some people have to take aspirin for other heart conditions, etc, and a very small number of people cannot take anticoagulats because of other things (eg other heart conditions).

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Also see Bob's comments on slightly earlier post today called aspirin.

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NICE guidelines June 2014 -- Aspirin has no place in stroke prevention for people with AF. It has properties which make it useful in some other cardiac conditions but not AF. Refer your doctor to those guidelines please. Aspirin is NOT an anticoagulant.

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You can start apixaban as soon as you have stopped taking warfarin and your descending INR reaches 2. Why wait until Monday? You're late now and you're unprotected for no good reason.

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Further to my last, you might have been the victim of advice that told you that you have to get warfarin 'out of your system' before taking apixaban and the advisor simply gave you an approximate start date. That advice is wrong. You are on anti-coagulants for a good reason and the last thing you want is for their benefits to be 'out of your system'. Take it as soon as possible.

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Was it a GP who told you that or a specialist Anticoagulation person? When switching from apixaban to warfarin the Anticoagulation nurse said I had to overlap. On a Monday had INR taken (1.2) then started warfarin Monday evening (took both then upto and including Friday morning). Went back for blood test Friday mornings do as it was over 2 they phoned me that afternoon and said stop apixaban. I obviously did not ask about the reverse because of no interest then.

At the initial warfarin clinic when my INR came back as 1.2 lead Anticoagulation nurse said there is often an difference of 0.1 between devices or venous tests, sometimes more. He also said some people not on warfarin naturally had a higher INR than one. I think that 1.4 was mentioned but can't be sure. In any event, as Relim said above, below 2.0 there is no protection. As I have some intollerance to warfarin which causes large swings my consultant has set therapeutic range as 2.5 to 3.5. I have to keep diet constant and no greens and even then I get swings. Recent weekly results - I was on 5.0mg INR 4.3 so they dropped to 4.5mg and next week INR was 2.6. Increased to 5.0mg and INR went up to 3.3.

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My husband went through some tests to determine if his heart was strong enough for Eliquis (apixaban is the generic), so he was off warfarin for several days before the switch without any harm. You should be fine.

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