Cardioversion - missed dose of Apixaban

I know this issue pops up occasionally, but one of my friends was due to have a cardioversion this morning, but when asked the question, he told the doctor that he had missed one, possibly two doses of Apixiban during the previous 4 weeks so the procedure was cancelled. He said that he had wished he had told a fib, but when made aware of the potential risk of dislodging a blood clot and having a stroke, he was rather glad he hadn't......

[Hidden]

This then is the drawback of NOACS. You can forget to take them and you are unprotected. At least you have the reassurance of INR testing with warfarin.

[Hidden in reply to Hidden]

Well......I was on warfarin prior to my CV and INR was doing very well for 4 weeks. I arrived at the hospital the morning of the procedure only to find it had dived to 1.8......mine was cancelled and I had to wait 4 weeks!!

[Hidden in reply to Hidden]

Flapjack...maybe I should have qualified my post by adding that self testing is the greatest help with warfarin! Wouldn't be without my Coaguchek kit....takes away all the worry.

[Hidden in reply to Hidden]

I know, but in this case it wouldn’t have helped. I was having weekly INR checks prior to the CV, but my mistake was having broccoli with my dinner the night before, so like my friend forgetting to take the tablet, all down to personal error! My house chimes like Big Ben now when it’s tablet time!!

[Mekelly in reply to Hidden]

Tiff oucvv

[Hidden]

Sorry flapjack but broccoli is unforgivable!!😑

[Hidden]

U ain’t wrong.........😭....pardon the pun, but I was green in those days!!

[Hidden in reply to Hidden]

I don't agree here. Broccoli has only a medium amount of vitamin K. Kale, spinach and spring cabbage (collard greens) are much higher. The front runner by a long, long way is parsley.

[Bagrat in reply to Hidden]

I continued to eat REGULAR amounts of spinach when on warfarin the theory being any other ups and downs of vitamin k would fade into insignificance. I'm sure there are people on here who take vitamin k supplements to stabilise their INR though I have no experience of this. Now on Apixaban and have alarm set twice a day on phone!!

[Hidden]

According to my Vitamin K app:

Broccoli, Frozen, Boiled 1 gram contains 0.881 mcg

Spinach, Frozen, Boiled 1 gram contains 5.407 mcg

Parsley, Raw 1 gram contains 16.400 mcg

[Barb1]

I have never had a cardioversion without a TOE first so surprised he was just sent home

[wilsond]

Who would have thought Parsley was a dangerous drug??!! My dad used to be on Warfarin after a triple bypass and valve replacement,and was a big parsley fan! I recall him saying about broccoli,spinach etc but not parsley.You live and learn!

[Hidden in reply to wilsond]

Broccoli seems to have such a bad reputation but it's well below a few other things and parsley doesn't seem to be regarded as being very high in vitamin K (though it is) probably because you don't usually eat a lot of it.

[Mike11 in reply to wilsond]

I don't think you could eat much parsley whereas you could easily consume enough broccoli to make warfarin totally ineffective. Maybe that is why George Bush banned it when he was president of our ex-colony.

[MarkS]

I've never really understood the fuss made about high Vit K foods. The key is stability of Vit K input. I take a Vit K2 tablet every day and also have spinach or broccoli most days and lettuce every day. My INR is in range nearly all the time and I know others who follow a similar process who also achieve very high TTR's. Even when I went to India and went veggie for 3 weeks, my INR was surprisingly stable and I didn't even have to change warfarin dose.

[Hidden in reply to MarkS]

The problem, Mark, is for the few of us who fail miserably with stability, who take 9 or 10mgs of Warfarin per day yet can have an INR of 1.6. It can make anything green feel very dubious.

I accept that the best course of action is to let the dose go up, and as Bagrat says, eat regular amounts of spinach, but that can be hard to do if you are totally unsettled by it all and cross questioned at your every appointment.

[Hidden in reply to MarkS]

I didn't expect my original post which was simply to make people aware of the risks of missing doses of their DOAC's in the 4 weeks prior to a CV, to develop into a debate about the issues surrounding green vegetables,, warfarin and INR, but hey ho!

Mark you are clearly one of the lucky ones who enjoy stable INR. Of course, we are all different and many find it much more difficult to achieve which is why, I guess, some make a bit of a fuss about it.

[MarkS in reply to Hidden]

I agree - we've gone completely off topic. I also agree, there some who can't get stable on warfarin and for those DOACs are great, and I should have made that clear. But for the majority of people, warfarin stability can be achieved and it's those I was trying to address.

Getting back to the original post, I would have lied and said I had taken all my doses like a good boy!

[Hidden in reply to MarkS]

My friend told me that he suggested the doctor should ask him again in order that he could reconsider his answer. When the Doc finished explaining the possible consequences of what might happen in terms of a possible stroke, he agreed to the reschedule option!!

[Hidden in reply to Hidden]

It was a fun diversion, Flapjack. Thanks. Sometimes we all need a extra humor in our day. Thanks. During the 3 years I self-tested, I learned how to lower and raise my own INR with foods. Everyone knows green veg can lower INR but there are also foods that raise: garlic, cinnamon, turmeric, many Indian spices, etc. Worth looking up these. also used to set my phone alarm to remember my coumadin. Thank goodness I'm off anticoagylants now.

[Hidden in reply to Hidden]

Hi Flapjack. It was a good thread. Not only answered questions but added general knowledge from many different sources. To me a sign of a good exchange of info. Thanks. irina

[Hidden in reply to MarkS]

LOL Hi MarkS. Pres B didn't exactly ban it-he just wouldn't eat because he didn't like it. (You could get it on the black market, though, until the Broccoli industry restored its reputation!!)

[UScore]

I guess a cardioversion is different to my ablation/anti coag experience. Possibly because cardioversion means you've been in AF for quite a while and therefore had more chance for a clot to develop?

When I phoned Cardiology in a panic 2 days before my ablation because I'd forgotten to take my Apixaban the night before, they weren't in the least bit bothered. Didn't even have to do a TOE. I'd assumed I'd blown it and they'd either cancel the procedure or shove equipment down my throat. They didn't even blink at my confession.

[Hidden in reply to UScore]

Dr's thinking can go both ways on this-cancel or not. Maybe this particular doc had a bad experience in the past and wanted to be extra conservative.

[UScore in reply to Hidden]

I expect that the patients CHA2DS2-VASc score is taken into consideration too.

[Hidden in reply to UScore]

True. This doctor prob had several reasons for his decision-knowledge,past experience, his own conservative or liberal traits. We'll never know.

[Hidden in reply to UScore]

Also the cardioversion itself can shake clots loose leaving them free to travel. CV is quite a jolt.

[Hidden in reply to UScore]

I suspect that it's the condition of the patient's heart and their CHADsVASc score that helps determine the likelyhood of the patient having a stroke. Add to that the question, are suitable facilities close at hand to deal with a stroke should it happen and the risk of possible litigation if it all goes horridly wrong all because the patient failed to take medication.......maybe it's not surprising many opt to cancel.