Long-term anticoagulant/Apixaban use - AF Association

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Long-term anticoagulant/Apixaban use

Pikaia
Pikaia

Hi all,

My three cardiologists (lucky, I know) have all agreed I should be on an anticoagulant. They (and I, I guess) have settled on 5mg twice a day Apixaban.

I have a few questions that I hope veteran Apixaban/general anticoagulant takers may be able to answer:

1. Are there any dietary issues with Apixaban?

- I only have the odd pint here and there. I assume that's OK?

- No one has mentioned any food I cannot eat, but I've heard rumours of grapefruit and cranberries being out. Does anyone know if that's the case or if there is anything else I should avoid?

2. Ways to cope if I have a bleed?

- I cycle and of course, I'll fall off my bike once in a while. Is there anything I need to consider in my new anticoagulated state? (other than always wearing a helmet)

- Do I have to restrict rough and tumble play with my kids?

- Will I bruise more easily? (and if so, does it mean anything other than looking beaten up?)

3. Long-term use of an anticoagulant

- I'll be on this for the rest of my life, barring an unexpected medical breakthrough. Does anyone know if there are long-term effects of being on an anticoagulant (e.g. on liver function) and if there is anything I can do to mitigate them?

Thanks in advance all.

21 Replies
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The only dietary issues I know of with Apixaban are - avoid NSAIDs which can enhance anticoagulation, grapefruit juice which can affect absorption/elimination of the drug and anything with St Johm’s wort in it.

I don’t know of any interaction with the odd pint - I became teetotal on diagnosis of AF.

If you have a bleeding cut, assume that it will take roughly twice as long to stop completely. I have found that this is a good guide and apply pressure for a bit longer than previously.

I have become more carefully aware - avoiding the business end of knives and sharp objects and taking more care on ice etc. Bruising seems to be a personal thing - I haven’t noticed it worsening in the five years I’ve taken Apixaban.

You certainly should have liver/kidney function blood tests done by your GP - mine are done twice yearly to test that the drug is being excreted properly by your kidneys. Long term use is still an unknown quantity as Apixaban has been around for under 10 years, so we do take it somewhat on trust - like so many other things in life!

At the beginning, I was anxious about taking it, but it does become a familiar companion after a while. Also, it should be taken on time twice daily - many people use an app to remind them. Especially important if your daily routine varies and you are likely to forget. Good luck!

Pikaia
Pikaia in reply to Finvola

Thanks. I'm toying with becoming teetotal, I'm sure I'll go that way sooner or later.

I'm happy on Apixaban and prefer it to Rivaroxaban. About bruises - if on have a bad bang be sure to put a cold compress/bag of peas on it. I have had a few haematomas, two on my face from a fall, and one on my leg a year ago which left a lump 🙁 I'm much older than you so maybe won't be problem for you now. Good you are wearing the helmet, not wanting to alarm you but Vonnie posted a question recently about head injury and I posted the NHS advice which I think is worth knowing though I want to stress I came by the info in A&E after a violent headfirst fall but didn't have a brain bleed 😀

Pikaia
Pikaia in reply to Buffafly

Thanks. I'm concerned about that kind of bleed, but I guess it's all about risk management.

1. Are there any dietary issues with Apixaban?

No - I've eaten a diet normal to my pre apixaban diet. With drinking you need to remember they can increase the side effects/diminish the effect of many different meds. I haven't drunk anything major for years as a result, and max I've had in a 3 month period is 2 drinks at a wedding.

2. Ways to cope if I have a bleed?

I've had very little bruising compared to being on Warfarin. I've bled more than being on nothing, but again not as much as being on Warfarin. Handle it the same way as any other, elevate/compress the affected area and if it doesn't clot go to A&E.

Also, my apixaban came with an alert card which I carry with me stating condition/meds/doctors/next of kin same as my phone does.

3. Long-term use of an anticoagulant

Sorry, don't know. Been on them for periods of a few months but normally off them in "stable" times when I thought the AF was solved.

Thanks. In terms of coming off them when your AF was stable, how did you know? I thought one could have little episodes of AF without necessarily knowing and that these episodes also carry a stroke risk?

My chadvsc2 score was 0. Talked to EP and local cardiologist who said I'd only really need to be anticoagulated on during and after an ablation which entered the left atrium. I wasn't anticoagulated for flutter ablation.

I've taken Apixaban for around 3 years and no problems. Finvola has covered the dietary, bleeding and bruising issues but for obvious reasons, there is no long term information about DOAC's. The annual/bi-annual blood tests are important. There is no suggestion that Apixaban will have any adverse effect on either your liver or kidneys, but if their functionality deteriorates due to health or age issues then adjustments are often made to the dose...….

Something else that you might like to think about: Each pack of Apixaban comes with a card you are intended to fill in and carry with you, to inform medical personnel that you are ant-coagulated. I collect them all, and now have one in each and every coat that I wear, and every bag I carry as well as in my wallet and one in the car. I have also bought myself some wrist bands. I have a white silicone wrist band that states "Apixaban Anticoagulant" and a decorative steel bracelet with the word 'Apixaban' on it, but the one I like the most is a leather strap with a metal plate which has both my name and 'Apixaban Anti-coagulant' on it.

Having taken these precautions against disaster, I try not to get too worried any more. I'm an active wood worker (hobby) and often injure myself one way or another. Yes, I bruise easily, but I was going that way prior to getting AF.

Pikaia
Pikaia in reply to momist

Thanks. I think I'm the same as you. I'll do my best and take all the precautions I can and then I'll try not to worry about it.

O have been on Apixaban for 2 years.I eat what I like and have the ocasional alcoholic drink, no problems. I travel a lot around the world with no worries about testing like warfarin.

I sometimes cut myself shaving or cut a finger, little bit of pressure and it stops. Never been a problem.

Carry on as normal and enjoy life, don't be alarmed by some of the stuff you read or hear.

Good luck!

daveyboy123
daveyboy123 in reply to gateman

Exactly as Gateman has said. I don't have any problems with diet. I go out every Sunday and have my 3 pints, but never go over that as I have problems. I do cut myself on occasions like everyone but I don't appear to bleed excessively. Just do as you did before or you get fixated.

Pikaia
Pikaia in reply to daveyboy123

Both your and gateman's responses are exactly what I need to hear. I just want to take the tablets and get on with my life. Thanks both.

As a cyclist myself my concern on switching to Apixaban from Warfarin was mainly due to not having an antidote. I had a fall where my glasses imbedded themselves into my eyebrow resulting in quite a severe bleed requiring 7 stitches and 7.5 hours in A & E. I did bleed quite a lot but a good compression bandage eventually sorted that. I had a brain scan as well and fortunately no internal damage/bleeding. I did have to go back to A & E minors the next day to have it redressed as the wound was still weeping. Stitches out 7 days later and again some weeping but fixed with glue. 5 weeks on and the scar has healed nicely but still have some swelling on the eyelid. Been out for a couple of 40 mile rides since with no ill effects. My ablation was last October, had one follow up and just got another one for May. I am expecting lifelong anticoagulation and will ensure that I get the regular liver/kidney function tests, the GPs seem to be quite lax about this. I have restricted my alcohol intake (nothing for 6 weeks post ablation) but still have the odd glass of wine with dinner and a few pints on a Friday night (bus not cycle now). As previously said always carry an alert card. I set an alarm on my phone for the evening dose as this is the one I am likely to miss.

Dr. Day has some interesting thoughts on the need for lifelong anticoagulation:

drjohnday.com/13-reasons-wh...

DK81
DK81 in reply to Franny50

The article is interesting, but the case against taking blood thinners is defeated in the final sentence: "If my heart ever did go out of rhythm, I would immediately get on a blood thinner."

Pikaia
Pikaia in reply to DK81

Indeed. Quite a thoughtful article. I agree with the author that CHADS-VASC may not be perfect, but it seems the best we have. I don't want to be on anticoagulants for life, so I hope a more reliable system to calculate stroke-risk comes along, or, even more ideally, something is developed that 'fixes' my heart :)

Mary-miles
Mary-miles in reply to Franny50

Thanks for this article Franny.I am going to copy it and bring it to my next appointment with myE/P cardiologist.I agreed to stay on rivaroxaban for one year post ablation.We will now have some data and more information to discuss re ongoing use of med in the long term.

I’ve been on Eliquis for almost three years and have had no major probs- walk regularly and work out with weights three times weekly. There is now a reversal agent in case of major bleeding, and the risk of major bleeding is less than with other anticoagulant drugs currently available. One caveat- I would not bicycle, because the risk of a major brain breed is signicant if you fall and hit your head.

Pikaia
Pikaia in reply to Xerxes8840

Thanks. I'm planning to leisure cycle, but a fall is a concern.

GordonS
GordonS in reply to Xerxes8840

The reversal agent hasn't been approved for use in the UK as far as I know.

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