Well, my first day on Apixaban today. I have been on Warfarin since 2005 but recently my INR readings have been all over the place - last but one was 6.7, the highest it has ever been.
Anyway, Apixaban it is. Can anyone tell me how I will know if my INR is OK - if indeed that is the measurement with this. I felt OK knowing my Warfarin result every few weeks, good or bad, but what happens now? Feel a bit in limbo 😀
Cheers
The advantage of Apixaban - indeed all DOAC - is that you don't need to worry ever again about INR as it works on inhibiting a different part of the clotting process - not by inhibiting VitK. They are anticoagulants that directly target the enzymatic activity of thrombin and factor Xa instead which I can't remember is earlier or later than VitK anatagonists? Anyway the result and benefits are:- no dietary restrictions, no INR clinics, no worry about benig in range. The only thing you need to remember is to take it twice daily at roughly the same time ie- 12 hours apart. You don't need to take with food, just water.
Ian - Beancounter can explain the details of the process much better than I - if you need to know.
Thank you CDreamer. Yes, I would like to know more about it Ian? Maybe some direction on the more reliable sources. x
T'is very different Froggy, INR will become a thing of the past......normally you would have a blood test in three months time to check your kidney function and thereafter it should be checked annually. Apixaban doesn't affect the kidneys but they enable the natural removal of the medication (cannot think of the medical term!!) which is why they are tested annually.
How do you know it's working......I guess we have to put our trust in NICE and maybe slightly pleased when we bruise easily and when cut's and nose bleeds take a little longer to stop. I suspect the benefits of being able to eat almost anything without worrying and not having regular INR checks will soon outweight any of the concerns you currently have.
Hello Froggy - I came into anticoagulation via Apixaban, so never had the comfort of knowing if it is working as it should - in fact I didn’t know INR and testing existed for Warfarin until I read about it here.
We are told Apixaban works, just as we are told other preventative medicines work and I take NICE and its role as my safeguard.
The only test needed is an annual blood test for kidney/liver function.
Ian’s explanation of the process was one of his recent replies and should be easy to find in his profile replies.
Hope you find it as OK as I have - on it now for over 4 years.
The short answer is that DOACs are better than warfarin for most people.
The long answer is that the tests used to measure the effectiveness of the DOACs are not routinely available at present. So you have to trust that the dose has been correctly calculated.
It isn't difficult to keep the INR in range with home testing. I believe it was MarkS who found a paper that Warfarin was superior to the DOACs if greater than 90% of results of INR were in range.
Sorry to but in😬 but if there is no testing for DOACs how do they no its working?? That concerns me .
elmmb.nhs.uk/_resources/ass...
As you can see from the article linked above, factors including age, weight, renal function, other medication are taken in to account when calculating the dose. I don't know for sure, but I imagine the clinical trials which established the safety and effectiveness of the DOACs, did take in to account tests which are certainly available to monitor the DOACs. It's just the case that at present these are reserved for special circumstances and not available in general use like the INR At least not at the moment
In my opinion, home monitoring and adjustment of Warfarin dose remains the gold standard if you can stay in range 90% of the time, but that has been increasingly challenging for me recently, and the GP who runs our Warfarin clinic has made it clear that she will not accept me changing the dose while she remains responsible for mistakes I might make, which is a fair point.
So I have accepted this is one battle I won't win and it's transitioning for me next week, to Rivaroxaban that is.
Ok 👍🏼 got ye . It’s so frustrating all of it and confusing as well . They say well maybe a stroke risk or a bleed your choice??? About being on any of these meds . My chad score is 0 but I am sure it’s a 1 for being a woman, but still low and I have seen a family member have a bleed that wasn’t on any medication that ended up in a wheelchair now paralyzed. Also seen what a stroke can do to you , it’s a hard one to take and choice to make .
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