Log in
AF Association
16,042 members19,098 posts

Apixaban and blood clotting

I have occasionally seen posts about bruising caused by Apixaban, and rather more posts about the possibility of internal bleeding, with serious associated health risks, especially when bleeding occurs in the brain. I have been taking Apixaban for several months to reduce the probability of a second stroke. My experience with this drug is that I do not get bruising, and whenever I cut myself the blood seems to clot easily. For this reason I asked for a blood clotting test, and was informed subsequently that the result was "satisfactory". At the time the blood sample was taken I was not asked when I took the last Apixaban tablet. (It was actually between three and four hours earlier.) I meet the age and weight criteria for taking this drug at the usual dose, but sometimes I wonder whether the drug is actually doing anything! I am hoping for an interesting discussion on this topic.

38 Replies
oldestnewest

I would expect nothing less DK81. These drugs work. End of story. There are far too many scare stories out there in my opinion which may lead people to unwise decisions. Thank you for your input.

6 likes
Reply

Ian naturally suspicious about drugs but feel perfectly happy with Apixaban. Not all drugs work in the same way and if you read up on Warfarin you will see how it works in the body.Then do the same for Apixaban. Warfarin and all its INR testing and food restrictions drove me nuts and stressed me.It was a happy day when I changed from Warfarin to Apixaban.Incidentally, I never got bruising with Warfarin and do not get it with Apixaban either

4 likes
Reply

I was quite sure I'd have a brain haemorrhage when I started taking an anticoagulant, or a nasty accident. Something was going to carry me off very swiftly. It seemed to be less bad than having a stroke. I felt extremely moribund and vulnerable. However, I have become very complacent as nothing has gone wrong. Five years on, and I am more at risk and it just feels right to take advantage of the medication that's available to us today.

5 likes
Reply

Hi Rellim. I don't have to have an anti coagulant until I'm 65 but I have the same fears that you had at the start. It's quite disconcerting even thinking about taking it. Hind sight is a wonderful thing but I have to go through that journey yet. It's always nice to hear people talking positively about it. As Bob has just commented there are far too many scare stories about the medication & anxious people such as myself take it all in unfortunately

1 like
Reply

I've a great sense of protection!

Normal people all live their lives with the possibility of having a fatal bleed and we are very complacent because it's something that very rarely happens. At first it may feel very dangerous to be taking an anticoagulant but in fact it just moves us along a the line little bit and although we do hear the odd tale of woe, I think one has to have a combination of unfortunate circumstances to come to serious grief. I think most of us soon find odd cuts and bruises are barely worse than usual.

One problem I had was that I bitterly resented the fact that I was taking medication for something that was very rarely there. I think I calculated we were 3000 hours into the year and I'd had AF for only 30 of those hours and I feel fairly OK when I have AF. I'd been having wobbles for many years and felt the doctors were making a song and dance of it - and they all made an effort to paint a very frightening picture on the stroke front.

5 likes
Reply

It is just these kinds of events that apixaban is designed to prevent. Short bouts of afib are just as dangerous. Having suffered a stroke prior to being Dx with afib and put on apixaban,from which I've had no side effects or abnormal bleeding, from a personal experience I wish I had been on apixaban all along.

1 like
Reply

The risks were made very clear to me! I was over 65 at the time that anticoagulation was first mentioned and I am sure it was appropriate but it felt extremely dangerous for quite a while. Not any more, however.

Reply

Rellim2– you took my words!! That is exactly how I felt!!!!! I went from fear about taking the anticoagulant to them being an assuring comfort !

Reply

But now I am scared again as someone on this thread just wrote that they had a stroke while taking an anticogulant. Didn’t even know that was possible! Good-Gosh!

Reply

Anticoagulation makes strokes much less likely but the risk does not disappear completely.

Life's chock-a-block full of danger. It's surprising really that we nearly all manage to grow up and survive for as long as we do!

1 like
Reply

I still say this worry is caused by the misnomer "blood thinners" which makes people think they will spontaneously bleed for no reason.

7 likes
Reply

Hi DK :-) you say...

'['My experience with this drug is that I do not get bruising, and whenever I cut myself the blood seems to clot easily.'']

I have found I do bruise more easily on Apixaban , I don't bleed more profusely but I think cuts take longer to stop bleeding which is not a problem because I know I have to apply pressure to the wound.

I have no hesitation in taking Apixaban, I am aware it will have been extensively tested by the pharmaceutical company before it was released to the public.

3 likes
Reply

If I have read your post correctly you are wondering whether there is any point in continuing to take apixaban because you don't bruise, your blood clots normally when you cut yourself and the result of the clotting test was 'satisfactory'. Is that correct? If so, I think the real point is that you have already had one stroke and, as BobD says, what the medication is doing is ensuring that any internal future clot has less chance of forming (and potentially causing another stroke) rather than that your blood is being thinned. Using the term 'blood thinner' does tend to mean that the lay person is led to think that they are at risk of bleeding to death if they take an anticoagulant, whereas I think what one needs to focus on is the fact that the risk of a stroke is reduced.

I'm afraid I am no scientist and don't know or understand all the chemistry involved here, but I do take apixaban and I do bruise more easily. Those on the backs of my hands can be unsightly, but not once have I worried that I am in danger of bleeding to death and have been assured by a cardiologist I trust that the bruising is not a matter of concern. If I had already had a stroke there's no way I'd think about stopping taking an anticoagulant.

(With apologies if I've got the wrong end of the stick here)

5 likes
Reply

The point I wanted to make is that I expected the anticoagulant to manifest itself in visible terms (bruising/clotting performance, etc.). The absence of these signs caused me to question whether the Apixaban was doing anything to reduce clotting tendencies in my heart. Thank you for your contribution, and I hope this comment clarifies my post.

Reply

I understand what you're saying, but don't know enough to respond. Someone better informed than I am may be able to help.

Reply

Why?? It works as it should. There are no tests but if you want to feel that you can see some physical manifestation of anticoagulation maybe you should change to warfarin and see your regular INR tests?

3 likes
Reply

How did you manage to get the clotting test you mentioned? Do you know what it was?

The article below seems to suggest sampling interval after last dose is relevant.

onlinelibrary.wiley.com/doi...

And courtesy of ectopic1 the article below is about apixaban and therapeutic range/ blood levels

ema.europa.eu/documents/pre...

Reply

Apologies for the slightly delayed reply. The second article would not open yesterday.

As far as the clotting test was concerned, I mentioned to my GP that my blood seemed to clot normally whilst I was taking apixaban, and wondered whether a clotting problem had caused a blood clot in my heart in the first place when I was not taking any medication. He agreed to the clotting test, but added that he doubted there was any prior clotting problem. I have no additional information about the actual blood test, and have not discussed the result with my GP. Whether the test was done appropriately or not is difficult to determine.

Both the articles you cited are interesting, but I find them difficult to understand. I agree that the sampling interval after the last dose of an anticoagulant is deemed relevant (first article). Also, the tendency for bleeding incidents to occur is not easy to assess for any individual (second article).

I feel that by raising the topic in the first place some useful airing of the issues has occurred, and I feel personally somewhat reassured about my situation, and hope that others may feel reassured themselves. As far as firm conclusions are concerned, I would say that this aspect is well beyond what this forum can deal with.

Many thanks for your contribution to the debate.

1 like
Reply

Hi DK81,

I have previously taken Warfarin and changed to Apixaban because Warfarin was causing me issues. I took Warfarin for about two years and now Apixaban for about the same time. Like most people, I have had all the usual concerns regarding both medications.

Just recently I had a very nasty cut and as you can imagine, I was concerned I was going to have a problem with excessive bleeding. I am glad to say, it didn't happen.

(I don't think it's my imagination that I have noticed on both Warfarin and Apixaban that my blood looks more watery than before either, so have not worried that either drug is not doing what it should).

I applied constant pressure, got myself off to A&E, had a couple of stitches and other than the wound taking a few days longer than would be expected to heal (the Dr warned that this would happen due to the medication's affects) and having to be careful looking after the wound, had no problem happily.

I did find I bruised more easily taking Warfarin and seem to experience less bruising with Apixaban.

We all learn from our own experiences and as Carole F feels, I too feel reassured about how Apixaban is working. I am rather glad that Apixaban did not cause a major issue:))

Regards

Mickey16

Reply

Anticoagulation does not affect the viscosity of blood - they DON’T thin blood, although many people call them that.

1 like
Reply

Hi CDreamer I didn't say it did. I was trying to explain my fears... which is what DK81, I think was expressing - it does affect clotting, otherwise we would not be taking them would we?...

Kind regards.

Reply

Mickey16

Funny you mentioned that - I have noticed that more “watery” appearance to my blood as well! Interesting.

1 like
Reply

Just a thought DK81, I’m not medically trained, but folk start taking statins start because their cholesterol is measured as being too high. Their initial doses are adjusted until their cholesterol reduces to an acceptable level. After that, their cholesterol is checked maybe annually (or maybe not) because the statins are assumed to be working as determined by exhaustive testing, consequently, all being well, they are protected against the risk of having a stroke. I could well be wrong, but I believe the same principle applies to Apixaban and the other DOAC’s because the testing process is similarly exhaustive. Comparing their effectiveness in the way they work with Warfarin (with its unique testing process) is probably not going to achieve much because work in a very different way.....

2 likes
Reply

This is perhaps a strange analogy but I once had a patient on a chemotherapy drug which "can cause hair loss". Because he did not lose his hair he worried a great deal as to whether the treatment was working. It became apparent it was. SOME people get bruising etc with Apixaban others don't. Please try not to be concerned.

4 likes
Reply

Hi DK81

I’ve been taking Apixaban since last November. No side effects that I have noticed. Like you, I didn’t appear to bruise any easier and on the occasions I cut myself shaving the blood seemed to clot as before. The evidence seemed to suggest that it wasn’t doing anything.

However, a couple of weeks ago I had an altercation with a tree (don’t ask - a stupid accident that I really should have seen coming 😖). The tree won and I was left with a cut on my head and a couple of grazes on my nose. Even with no dressing, they took a good 2 or 3 days to dry up. This was longer than I would normally have expected so have concluded that Apixaban works 🙂

2 likes
Reply

I don’t bruise or bleed excessively with minor cuts but the concern is for anyone on anticoagulant who suffers a major, internal bleed after trauma or a fall - which cannot be seen - so could be happening for hours without being known about or treated. This is life threatening for anyone but taking anticoagulants there would be a slightly higher risk. I understand that there are some people for whom the risk is higher and that is why doctors consider HASBLED questions before prescribing as anticoagulants may not be appropriate for everyone.

A very personal opinion but I think people stress about this far too much and not enough about clot stroke risk - Risk:Benefit ratio.

1 like
Reply

Having also had a stroke during an episode of pay3, at the age of 52, I have been started on apixaban. I have read fairly extensively about strokes with af, and understand they are often catastrophic as they are usually in the cerebellum which is the first area a clot will 'hit' after leaving the heart. I would much rather a smaller risk a bleed elsewhere in the brain than a catastrophic stroke.

But I understand your concerns about whether it is working or not, as nothing to show for it. However the research shows it works, and this is the basis for all medical interventions!

Good luck.

1 like
Reply

Paf not pay3!!

Reply

BP tablets make me urinate excessively, Statins make my legs ache, Beta blockers make me so tired but having had a stroke I would take Apixaban even if it did cause side effects other than small amounts of bruising. What can I say I am clumsy..... however when I hit my head on the bathroom cabinet ouch ! That did bleed but at least I know the anticoagulant is working. Thank you Apixaban I feel safer in your hands.

1 like
Reply

I strongly agree that the misconception that anticoagulants "thin" the blood causes a lot of unnecessary anxiety. There are risks with anticoagulation but these are outweighed by the benefits.

One thing I would strongly advise is that anyone on anticoagulants wears a medic alert bracelet or breathless

3 likes
Reply

hi there ,I'vebeen on apixaban since my second ablation and had a episode of a/f on the 17 aug. then on the 20th i had a stroke.i also don't bleed or bruise so who knows ? because I don't .waiting for my 3rd ablation ,the first was a complete mess up but 2nd worked for 9 months.Best of luck to you all out there

Reply

I'm so sorry to hear this, but anticoagulants (as I am sure you know) don't eliminate the risk of stroke, but they do reduce the risk significantly.

Reply

What? That’s terrifying. I didn’t know that! You mean a clot could still form even if you take your anticoagulant as prescribed?

Reply

Yes. I'm afraid so.

"Anticoagulants reduce the risk of stroke by nearly two thirds. In other words, these treatments can prevent about 6 out of 10 strokes that would have occurred in people with AF." (from patient.info/health/atrial-...

However, taking your anticoagulant as prescribed is definitely worth it - in my humble opinion - and particularly if your CHADsVASc risk score indicates that you are at an increased risk of a stroke.

2 likes
Reply

It's rather opportune that this thread has appeared. I was thinking the same thing in that the rare times I cut myself shaving, it seems to clot even quicker than it did before. They have only been tiny nicks though and I was even thinking about ringing my GP about it, but this thread has reassured me to to just leave it alone.

3 likes
Reply

I agree with you. I have also not noticed a big differance if I cut myself accidently. I seem to clot fairly normal. I am also on plavex too due to having 2 stents in. I also worry about brain hemorrhage as well.. whether you throw a clot or brain bleed both cause a stroke in the end so it makes me feel like I am playing russian roulette???Your concerns are not alone believe me and the side effects of these drugs is unpleasant as well. I have noticed an increase in appetite with some wgt gain, itching frequently and my hair has thinned out considerably.

Reply

I will add that yes I bruise often now.

Reply

Hello

I began Apixiban a week ago, after waiting nearly two years after it had been suggested by my cardiologist.

Why? Simply because when on a low-dose aspirin, I looked like a battered wife with bruises popping up everywhere - for no reason.

Reading up on Apixiban I noted the risk of bruising was indeed shown to be a possible problem and my vanity initially won. Recently speaking to a family member who is a doctor and musing about starting Apixiban - or not - I was asked the question 'do you want to die?'. The answer is 'no', and so I began the drug!

One week in, I only have minor bruising on the inside of my arms but not the large bruises I had whilst on low-dose aspirin.

Would anyone know if it takes a while for something or other to develop in my body (thereby increasing the risk of bruising) or, is this the level of bruising I can expect, taking Apixiban? I would be extremely happy if it was!

Having nursed my mother who had had several strokes, I feel that vanity should take a back seat and common sense take over as I would hate to be a burden to my own family. People on this forum are obviously the sensible ones.

Reply

You may also like...