Apixaban blood tests lack of knowledge - AF Association

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Apixaban blood tests lack of knowledge

Just got home after efficient and speedy nurse appt for the bloods and ECG I requested ( on Apixaban and Flecainide) For once appt was with Sister not one of our very good HCAs and she did both.

I mentioned I'd had to ask a GP for these checks and could it not be flagged up. She said they were looking into it as GP had written reason for blood test "Annual on Apixaban". She then said "lots of our patients are on Apixaban and we didn't know they should have yearly blood tests" I presume she meant the nurses though who can say? At least its now being looked into I hope.

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I think it may be due ,in some parts of the country, to too much work,too few nurses in a practice as much as lack of info. being passed on to nurses. I recently went a year and a half with no check up for bloods and i am on Apixaban.You really have to keep up with all this kind of stuff yourself and keep asking for the tests and checks and ask for them when you are due them.

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I quite agree though on this occasion she said she didn't know.

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My local GP is terrible at stuff like this, I have to book myself in. You would think that they would have some procedures in place

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I'm going next week for my first meds review I'm checking if I should have bloods taken as advised

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I use Google diary so its in for next year now!!

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I see I had a blood test while on Rivaroxaban a year ago, after being told firmly by nurse 'we don't do that' she did look up NHS advice then whipped out needle 😀 So waiting to see if I ever get called for Apixaban blood test. I have asked for access to my medical records so I will be able to check when due.

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Why did you change from rivaroxaban to apixaban can I ask?

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I have bowel problems which cause diarrhoea when I have a flare up and a fast is really the only 'home treatment', but as Rivaroxaban is supposed to be taken with a meal to be effective I thought Apixaban which only requires a drink of water would be better. Funnily enough, since I changed I have only had one flare-up. Very happy with Apixaban.

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Thank you. I may ask to change as I take my rivaroxaban with my evening meal,, but what with family, friends, going out, staying in, blah blah blah, I find it difficult to do dinner at the same time every evening.

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True, that was another problem. My GP said a few hours either way didn't matter though. I definitely have less bruising and small bleeds, don't know if that is good or bad.....

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Oh I was told it had to be within at least minimum time of an hour regularly each day. A few hours I could cope with.

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The pills don't suddenly stop working on the dot of 'midnight' like Cinderella's spell, they have what is known as a half-life which varies according to the medication. As far as I remember I had to stop Rivaroxaban two days before a procedure to allow it to clear my system. If I forget an Apixaban tablet I can take it up to six hours before the next is due. Taking them very regularly is the ideal of course.

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Thank you again Buffafly

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I have to book myself in for the annual kidney - function test as I take Pradaxa.

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Yes indeed we're all on the ball but I do get a wee bit concerned about those that aren't

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Sadly not surprised Bagrat, but to be fair, given how many ailments there are out there and the mass of medication around for treatment, I guess it’s not surprising that stuff gets missed.

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FlapJack I totally agree. Husband unhappy if prescription not all present and correct. I say the miracle is it usually IS right.

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Would you find the advice on NICE guidelines or Apixaban Information notes for annual/regular testing?

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Yes it's all there among NICE guidelines somewhere or in AFA website . Links have been posted before.

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This is not intended to be a political comment but I think we would have to be prepared to pay quite a lot more tax before we could complain too loudly about our surgeries skipping routine tests for apparently healthy patients. I suspect mine relies on you 'not feeling well' before they order any tests. I used to expect some communication when my prescription showed a review date but don't remember that happening.

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Buffafly I would be more than happy to do that. I'm pretty sure the instances of liver and kidney issues with Apixaban must be pretty small and I guess what I'm saying that technology is such that it would be comparitively simple to put checks and balances in place for many annual tests etc. We do take our amazing and extremely stretched NHS forgranted and have very unreal expectations at times.

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I too would be happy to pay more 'health dedicated' tax though as you say 'working smarter' might prevent many problems. I have sometimes thought it might be good for people to be aware what their treatment is costing but then the wrong people would be put off. It was impressed on me that my titanium rods cost 15000 even before the surgery but it didn't put me off - I'm worth it 😊

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One thing I’ve found since recovering from heart failure in 2013 , is you really need to question medical staff and do your own thorough research , doctors arnt gods like some seem to think they are , and must be questione for alternate medication and treatment , if your not 100% satisfied with the medical professional you have , get another one , at the end of the day if they mess up on your treatment , it’s YOU that suffers with your life , not them .

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I think doctors and other NHS staff do their very best within the constraints of the service that employs them . They struggle with mounds of red tape, policies and targets. I agree that the person who should invest the most in their health is the individual, but this is certainly not universally recognised and the attitude of many is that the medical or nursing profession should provide a cure with little effort on the part of the person concerned..

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I have yearly bloods done at my gp surgery in January. When i asked why i was told. The anniversary of my birthday month.

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Would the same be for rivaroxaban as I have been on this for 14 months and never had blood test for it. Is it a special sort of blood test to see how thick or thin the blood?

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No. No anticoagulants thin or stop thickening of blood. The process by which blood clots is very complex and whereas a blood test known as INR (international normalised ratio) can show you are on the right dose of warfarin, with direct oral anticoagulants ( NOACs or DOACs) there isn't a test. The annual blood test is to check liver and kidneys are functioning well otherwise the drug might accumulate ( i.e. not be excreted efficiently) and you would have too much in the body.

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Oh I see. Thank you

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There is a test for Pradaxa's mechanism. One of Bohringer's own scientists was tactless enough to suggest that using it would make treatment safer and more effective but he was told to shut up as no testing in comparison to Warfarin was a prime marketing strategy. There was a controversy about this in the BMJ.

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Interesting. Maybe I should have said no test available... thank you Auriculaire

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It is apparently a complicated test not generally available . So the labs at renowned hospitals might have it but not those in smaller towns.

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Cardiologist wanted to change me from Warfarin to one of the new ones, Apixoban etc. but ENT consultant said stay on Warfarin as easier to reverse it if I had another serious nosebleed. Told recently by nurse at Warfarin clinic that a lot of patients are being transferred back to Warfarin from the new drugs, she thought it was down to the cost of the newer drugs as Warfarin is cheap although it needs monitored, and that is the cost they are trying to reduce too. I find having it monitored even just every three months re-assuring that my blood is at least what it should be at.

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Reversal as far as I remember is not a very speedy business the DOACs are excreted quickly. I believe there are reversal agents for some DOACs now

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I get called into my Doctors, and the nurses take my bloods every 6 months. As far as I know this is for liver and kidney function, not sure if they do an INR test but assume that they do?

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INR would not serve any purpose unless you are on Warfarin in which case the blood tests would be more often.

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