I have moved from warfarin to apixaban today. I wasn't given a huge amount of information but told to stop warfarin 3 days in advance and then start on apixaban. I took warfarin on Wednesday and nothing thursday, Friday or Saturday. I took my first dose of apixaban tonight. My INR was down to 2.2.

So, how long before it kicks in. Anything I should be aware of?

What if I forget a dose?

Any info welcome

33 Replies

  • PS. That should be 1.2 INR.

  • Apixaban is usually taken twice a day I take mine 5mg 7am7pm had no probs in 2years

  • Take Apixaban started 4 weeks ago twice a day 5mg no problems so far

  • Well done llaym, a decision you will come to be very happy with , I'm sure. Change- over should ideally occur as INR passes 2.0 descending but it matters not as you have taken your first apixaban - and another this morning - so you are fully protected. And you will remain so forever without all that 'warfarin hassle'.

    If you are not informed, you should ask your GP for a liver/kidney function blood test after 3 months and then annually. This will just ensure that apixaban really is for you.

  • If you haven't had one in the last month then get it done in the next week and again in three months time.

  • Welcome to NOAC world, lallym! You should be aware that you are at all times fully protected, provided you remember to take apixaban on time. Your level of protection will not rise and fall; it will not need to be tested (apart from the checks AnticoagulateNow has mentioned). It won't be influenced by what you eat and you are now free to enjoy all those things that interfere with warfarin! How good is that?

    Don't forget doses! Set alarms and backup alarms and always take your medication with you if you are not at home in case your return is delayed.

  • There is no antidote with apixiban if you suffer serious bleeding. It is also unaffordable unless you have health insurance. The only advantage is that it does not need monitoring.

    The latter is a choice if you live very far from where you can get INR monitoring.

  • The constancy of the level of protection with a NOAC seems to me to be a big advantage, particularly for people who have trouble with INR levels.

    I also think the issue of serious bleeding and NOACs might sound more frightening that it need be. If it is bad enough, really serious bleeding is not going to be treatable whether you are on a NOAC, on Warfarin or not anticoagulated. Most superficial external bleeding can be sorted. Internal bleeding is more of a problem, but how common is it? How many people on Warfarin have had to be treated with vitamin K?

    NOACs are indeed expensive but happily I do not have to pay for mine. If I had to, I would willingly forego pleasures and live on porridge and lentils (plus cranberries) if necessary in order to do so.

  • The no antidote thing is hugely overstated. If you have a major trauma bleed (eg car accident) in the middle of nowhere you could well bleed to death whether you are on apixaban, warfarin or nothing at all.

    If you're in hospital, pressure pads, transfusions and other medical routines will keep you alive for the comparatively short time it takes for apixaban to wear off.

    Finally, unless you really are very old with other serious medical conditions, the chances of you having a stroke being not properly anti-coagulated is many, many times greater than having a life-threatening bleed because you are. And with apixaban you are much more likely to be properly anticoagulated than with warfarin. How many INRs are within therapeutic range at this very minute? A significantly high percentage won't be.

    You worry too much Tony though if you are not under the umbrella of the magnificent British National Health Service, then I can see that cost may become a significant issue.

  • Thanks for your reply and concern. But fortunately I do have a home coagulation meter and I take my IRN very regularly especially when I take new medication or change it. I also adjust my wafaran dose. So I keep my INR well controlled and dont worry. I also watch my diet regarding vitamin K. But the meter cost $1000 which is more than most people where I live can afford. It was a lot for me too but I think it was a worthwhile investment. but my wife described it as a new toy!

    Apixaban here is about GPP 1.75 a tablet and I believe that one has to take 4 a day?

  • I couldn't afford to be an American! lol

  • Not sure why your meter cost so much. 299 U.K. Pounds in uk.

  • I did check it out but that price does not include the test strips which cost almost another GBP 50. Also, there is no guarantee unless it is bought for the local agent.

    I bought it here in Thailand from Roche, who gave me an additional 24 strips (TOTAL 48)and a one-year guarantee locally. They also sent two representatives nearly 300 km to my home to instruct me in its use.

  • Magnificent NHS won't let me have NOACS. CCG has ruled they are too expensive to prescribe. My Specialist and Specialist Nurse are

    amazed but GPs now rule through Clinical Comissioning Groups. It makes financial sense but it's a pain.

  • That is wrong Janet. Your CCG does not have the right to hold back on NOACs. If you want NOACs you might have to thump the table but they're yours, as the patient, to be demanded.

  • Also as they give you a transfusion your own blood with the anticioagulant is diluted (ie if they transfuse in 50% new blood teh Apixaban is only 50% of what it was). Also Apixaban has a very short half life, hence why it has to be taken twice a day.

  • I have been on Apixaban for almost 2 years now. Each pack comes with a comprehensive leaflet with lots of information. There is also a patient alert card inside which is fairly new. Don'T dwell too much about no antidote - there are things that the medics can do in the event of a major bleed. There is no doubt Noac are the way forward. Keep well. Patricia.

  • I changed over like you 2-3 months ago without problem. The leaflet with the Apixaban suggest you should have an INR test after stopping Warfarin, and then, when your INR is below 2, then you start taking Apixaban. But all that's rather unworkable unless you have a home test machine, and I have, but I still didn't bother, so like you I stopped Warfarin, waited 2 days, then started Apixaban.

    I think it kicks in very quickly.


  • set your phone to remind you i do 9am 9pm

  • Hi being told to stop Warfarin 3days in advance of taking Apixaban is a clue to how long Warfarin stays in your body! Apixaban works differently,it has a short shelf life,so taking it every 12hrs is extremely important,I take mine 8am and 8pm (with phone alarm set for 8pm,also always have a supply in my purse for evenings out!

    Have been on Apixaban 12months in March- no problems at all! Good luck.

  • I had no anti coagulant at all until I had my first appointment with the EP last year - he put me straight on to Apixaban and I've not been aware of any problems. 2 x 5 mg daily morning and evening, It was a huge relief to me knowing that when I go into AF I am protected which I wasn't before.

  • I started Apixaban two months ago and feel very relieved that I am protected from stroke. I try to take it 12 hourly but not sure if I should be taking it after a meal - what do others do? My meals tend to be within a 9-10 hour period.

    Also I'd like to thank everyone who posts here as I've learned so much. My fear has been greatly reduced as a consequence. Thanks, Jane

  • I was told ok with or without food but drink water with it.

  • Really appreciate all your answers. I have a good EP and we went through all the pros and cons last October. He did renal and liver tests and all ok. Then all went quiet and I had stuff to do, then Christmas so only started nagging them recently. So they apologised and issued prescription and I picked them up in the pharmacy in the hospital. However I was expecting a knowledgable pharmacist who would go through the first days in detail but she knew less than I did. Anyway I have a home machine and tested after the third day, INR was 1.2 so off we go. I am aware of antidote issues but this was my decision. Anyway I believe one being tested so may be one soon.

    I also get mine free!!

    I have set alarms so hope all goes to plan.

    Again thanks to all the great members who responded.


  • Apixaban has a 12 hour shelf life as long as your kidneys are fully functional, so in 99% of cases as long as you remember to take the tablets you are fine.

    I developed a kidney problem that I wasn't aware of which meant the Apixaban built up in my system and I ended up with serious internal bleeding which they struggled to stop as there is no antidote.

    Yes NOACs make life easier but they do carry a small risk which you should be aware of when you make that choice.

  • Yes, I am aware of it but thanks for reminder as sometimes can be a bit blasé about it. Sorry you had such an experience so here's hoping I don't and fingers crossed.

  • Just a minor detail but it's not a 12 hour shelf life, it's a 12 hour half-life. The half-life of a given medication is how long it takes for the body to get rid of half of the dose. The shelf life is how long you can keep it on the shelf.

    Logically, if the half-life is short, then the time for it to kick in must also be short, otherwise it wouldn't work!


    PS. I'm not clever, I just Googled it.

  • Thanks Koll.

  • Was on Apixaban prior to my ablation. They now have me on warafin for three months then hopefully back to Apixaban again. While in the hospital for the ablation I was taking to one of the nurses about not having an antidote for apixaban. He said they use frozen plasma to reverse the effects of many anticoagulants including apixaban. Interesting

  • Apixaban kicks in right away, so you should not worry. My husband has felt muich better since he made tha same switch about a year ago.

  • Thank you all. As usual helpful and knowledgable

  • What is the normal does of apixaban .

  • Hi Souljacs 4,normal dose for Apixaban is 5mgs strictly every 12hrs,use a alarm to remind yourself,just in case you forget! I'm ok in the morning always take it 8am,but the evening 8pm one I use a phone alarm,if I'm out I tend to forget!

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