I changed recently -warfarin to apixaban. The initial prescription was from my EP and I had to go to the hospital to get the first prescription. I thought this was to do a careful swap. Instead I saw the chemist who knew less than I did. I was told to come off warfarin for three days and then start on apixaban. I did this and all went ok but thought it was not very carefully managed.
No problems with it and great - no testing or managing greens etc.
I did have kidney and liver function tests a couple of weeks before changing over.
Thanks Lallyn for that. I am going to see the GP tomorrow so fingers crossed. I have not much faith in the GP!s because very few of them seem to know much about AF. Not liking the sound of coming off Warfarin for 3 days- where's the cover during this period?
I have a coaguchek so I checked my INR during the three days. I read somewhere to start the apixaban when INR below 2. On the third day I was 1.5 so I think that all fits. It takes quite a long time for the warfarin to leave your system and apixaban kicks in quickly.
Have my INR check Thurs so will see what the reading is. I was thinking about getting my own coaguchek machine but will I still need to if I am changed to Apixaban?
You may have trouble getting your GP to agree. Why? Because you are in Wales. My EP took me off warfarin and prescribed Pradaxa because my INR was unstable. It is more expensive, and that's the problem.
I think that NICE guidelines indicate that you should be on your anticoagulant of choice. Look it up before you see the Dr.
Quite honestly if they were to discount all the INR testing and travelling then NOACs may prove to be cheaper, they're certainly less bother!
I will see the GP tomorrow and intend going in with all guns blazing. As you say if you discount the cost of regular INR testing this would surely make up for the extra cost of the pill.
I was told by anticoagulation clinic that the reason they only sue CoaguChek test strips on the initial occasion and a few other times is that the strips cost cira £1.50 a time but INR blood tests cost around 40p.
Look at the leaflets on the AFA website as there are at least a couple that will give you some good ammunition.
I went from apixaban to warfarin (so I could have an ablation) where I was taking BOTH from Monday to Friday morning inclusive. I was told that it was very important to carry on taking the apixaban until warfarin to ensure there was no gap in Anticoagulation. In fact other post response have highlighted that there are risks about temporarily stopping Anticoagulation (they were re dentistry).
I'm about to start Pradaxa before an ablation in the Fall. I don't understand why your Dr wants you to switch to Warfarin before ablation ? My EP said nothing about making a switch, thanks, Gracey
Well that was 15 months ago. Certainly my EP or possibly the hospital only did ablations at that time whilst a patient was on warfarin and they insisted on continuous dose (I'd no stopping for a few days). Certainly some now do ablations when patients are on a NOAC.
Peter, I think you're confusing changing from warfarin to apixaban which this question is about, to changing from apixaban to warfarin, which you had to do. One doesn't want to be anticoagulated twice over - that would increase the risk of bleeding!
Apixaban starts working at once, so one needs to phase out the warfarin first, and it is still effective for about three days. So . . . after three days the level of protection from the warfarin will have dropped (ie INR level below 2) and apixaban can start.
In the other direction, replacing apixaban by warfarin, it will take several days for the amount of warfarin in the body to build up (ie for the INR to become more that two) so one needs to take both until this has happened. Hence the need to take both at once.
I changed over a few months ago. I think you are supposed to have an INR test, and when it goes below a certain figure (2.0?) then you start the Apixaban. To be honest, being fairly used to my INR and just stopped the Warfarin, waited 2 days, then started the Apixaban. I'm not recommending that of course, it's what I did.
Not any issues or side-effects with Apixaban. It is soooo nice not having INR checks.
I must admit to feeling a bit nervous if the doctor does let me change to Apixaban, because Warfarin has kept me safe for the last 14 years. Am I going to regret the change if it happens?
I am about to change from warfarin to Rivaroxaban. I told my EP that I had terrible hair and nails on Warfarin so he suggested changing to one of the newer anticoagulants. You only need to take Rivaroxaban once a day, so I can take it and Lisinopril with my breakfast and then forget my medication. (I could never understand why they like you to take warfarin around 5 o'clock)
When I was on the coronary care unit (went to A&E to get a proper diagnosis of PAF), I was given the Warfarin at 5pm and told it was best to take it around the same time, as if I was admitted any time in the future this is when they would give it to me. I think that as long as you take it at the same time each day you will be fine. For some reason they don't like you taking it in the morning. Don't know the reason for this.
Different clinics use 5pm to 7pm as the time. The lead at the hospital clinic explained when I first started on Warfarin said 6pm and that the reason for doing this is merely because that means the results from all the INR tests are through and the nurses will have phoned all the people whose INR has shot high or shot low so that they can start their new dose ASAP rather than wait for the next morning to start the revised dose. Similarly the letters that are issued for all other patients will have arrived during the day and then people again can start new dose (if adjusted on the same day rather than waiting until the next. I take at 7pm so it is with food or just after.
I asked my GP if I could change to Apixaban as I like far flung holidays and my travel insurance won't cover me if inr is unstable needing less than four weekly checks.
GP agreed at once, no argument at all
By the way my inr nurse was all for it and very pro.
The inr nurse stopped warfarin and checked reading below 2.0 then off you go on apixaban. Eat what you like,do what you like. Just keep taking the pills.
I like far flung holidays too but now very nervous about taking them.
Never been on meds before, was always very fit, love life, but now am a bit of wreck waiting for side effects of Apixoban. Have only been on Apixoban for one week but have had two episodes (3 days apart) of mild dizziness but dizziness nevertheless and losing my confidence.
you sound very positive which is great! are you taking any other meds with the Apixoban? and which far flung places have you travelled to taking the antocoag and with your a fib?
I am planning to go to India in November but now thinking.......
I envy all of you having the NHS. Here in Ireland I can pay up to €150 each month for my meds plus €50 each visit to the GP. I work and so I fall ouside the free GP visits and the free meds. I also have private health insurance which costs close to a mortage each month. I dont have a well paid job but I need to work to remain in good mental health. I have been told by my consultant that Warfarin is a safer drug. It can be reversed quickly in the event of a brain bleed or an accident resulting in blood loss. My father in law had an internal bleed when he was prescribed an alternative anti coag. It took 2 weeks in hospital to fix. They never did find the cause of the bleed. It was undetectible but over a long period of time he became chronically anemic. Im not writing here to scare you but after seeing him I stopped annoying the doctor for a change to apixaban. I am now stable on Warfarin for past 2 years. I only get inr test every 2 months.
I always read everything I can when taking medications, so the first thing I questioned the doctor was about the lack of an antidote. I was assured there is now an antidote although you see mix info on Google based on the date it was published. I haven’t had a problem except some minor bleeding, gums, etc
I just went to my surgery and saw gp who was unknown to me. I told him I wanted to go onto noac. He asked which one and he agreed at once. No probs whatsoever.
Armed with my script next time I saw warfarin nurse she adjusted my warf to bring me below 2 which happened in one week.
Now on apixaban no reactions or problems and no worries about going out of range and associated problems.
Just do it and don't anticipate problems that probably won't happen.
I have not been on warfarin, went straight on to apixaban and find its fine, no side effects and it does not need to be tested. Sometimes I get a tingle at the top of my nose as if I am going to have a nose bleed , but dont have one, not even sure thats apixaban though?
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Changing to Apixaban
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