New here and just diagnosed with AFib. Need advice please regarding Apixaban.

[Eddie49]

Hi all. Please see the post below that I posted yesterday on the Anticoagulation forum. I was advised to also post here.

Fourteen years ago I had 'mild' heart attack and was put on a statin, blood pressure tab and aspirin. At the time my G.P. questioned whether I had really had a heart attack (but that is another story!). Two and a half years ago I went for a swim in the local baths and after about one minute in the water had my first AFib episode, was sent to A+E and reverted after about five hours. I was given a monitor to wear for two weeks but nothing showed so just carried on as usual. Five weeks ago on my 70th birthday I went to the gym to use the walking machine etc., which I have been doing for the past five years or so and consider myself to be reasonably fit. I then went to the beach for a very short swim, which I have done many times, and after five minutes had my second episode of AFib. So instead of partying that night with friends I was in A+E and reverted after about twelve hours. Apart from this I have had no issues. The consultant suggested I consider going on Apixaban and I am awaiting a stress test, Echocardiogram and a 24 hour monitor.

My wife and I are going to Japan in two weeks to visit our son for the rugby World Cup. I decided to hold back on the Apixaban until we come back. Reason: It seems that if you fall, or bang your head etc. you have to go to A+E, which could be a bit difficult in Japan. Also, I have spinal issues which causes nerve pain. For this I have been taking Cannabis Oil with good success. However, I have to stop this as apparently it can affect the Apixaban. I suppose my question is, am I being a bit stupid in my reasoning i.e. wait until after the Japan trip, have the tests and then make a more informed decision and stay on the CBD oil until then? My wife thinks I am being very foolish and that I have based this decision on the fact that I want to be able to drink lots of beer on the rugby trip. My normally low resting heart rate is around 50-55 beats but the stress of this is making it rise considerably most days. I mean, do I need to be on an anticoagulant now after only two episodes of AFib two years apart and before further tests? And the consultant said that I should 'consider' an anticoagulant Sorry if this post is too long, but any advice would be most welcome.

I suppose a supplementary question to that written above is - do I 'have' or am I diagnosed 'with' AFib or is it possible for these to be two totally out of the blue episodes that may never be repeated and therefore Apixaban could only be for the short term until more evidence is gathered? In other words, as the Beach Boys sang - 'Don't go near the water' and I might be OK.

Thanks

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[Hidden]

Short answer, yes. Because you have had an AF event, you are more likely to have a stroke.

Check out your chads2vasc score

mdcalc.com/cha2ds2-vasc-sco...

The risk of stroke does not change wheather you are in AF or in rhythm

[BobD Volunteer]

YES you are. AF makes us five times more likely to have a stroke and that is not dependent on how often or for how long. You can always stop anticogulation but you can't undo a stroke. And you only need to go to A and E if you have a serious injury by the way Think about it all the people on antocoags of different types are not clogging up our A and E departments are they? OK if you fell off a surf board and banged your head on a rock yes but a bump on a cupboard door ???

[Eddie49 in reply to BobD]

Thanks Mikee and Bob D. Ok, that's told me. I am now on the Apixaban. My wife thanks you too.

[Jalia in reply to Eddie49]

If I may add , please make sure that your travel insurance provider is aware of your history .

[Sebhel in reply to BobD]

I knew nothing about afib then from nowhere passed out! After extensive examination I was found to have afib and told about stroke risk. Eliquis was prescribed with a warning that it carried slight risk of haemorrhage. I then went through similar initial shock and panic but now have got used to it. Got to be careful, but keeping my fingers crossed!

[10gingercats]

Without meaning to sound a kill joy......lots of beer in Japan might not be too good for the Afib?But others here might advise on that more fully.

[Hidden]

True, alcohol is a known trigger for some.

Luckily not for me, but I have still taken the decision to reduce my alcohol consumption.

I probably average a pint of beer a month. Although it can be several in a night on the odd occasion

[Ianp66]

I went on Apixaban more or less straight as the risk of stroke so young at 45 wasn't worth it, and at any age I doubt it is . I also stopped drinking 5 years ago as it sent me into afib more and more with less consumption to the point a pint, or glass of wine would initiate it, just not worth the risk away from home until you find your limit, if there is one.

[Eddie49]

I agree that I do need to reduce my alcohol consumption as I can/do drink several cans of beer most early evenings listening to music in my summerhouse and looking at my wonderful garden. One of the reasons being that I have had two spinal operations, cervical and lumbar, and my thoracic spine gives me problems which causes nerve pain which no medication helps. The beer does though and doesn't seem to affect AFib. Only the damned water seemed to do that! So, I will be reducing - but am I strong enough yet? I honestly don't know because I haven't yet tried.

[Morzine]

What bob said it’s true....big accident yes but small one no....I get scratched my my cat a lot , bleed, and im in apixaban.....those little bleeds fix immediately. The last thing I’d worry about is an accident....I do however worry about a stroke.......I’m flying to Oz soon so long haul like you, the apixaban is a good idea for that too......I’d take it and just forget about it, it’s no big deal honest once you start taking it.....look upon it as your helper......

I only had one major attack, and a tiny one.....but immediately put in tablets....think the rule of thumb is once you’ve had it you’ve got it that’s how I understood it.

Yes I fully understand the beer thing.....I loved my wine.....everyonetolerates alcohol diferent,y I’ve gathered from this forum.....

Have a nice time in Japan !! Try not to think about it too much and enjoy the rugbyeh!

Sue

[Eddie49 in reply to Morzine]

Thanks Sue. I suppose it's just a matter of getting my head around my new situation. I have already been helped by posters here and I will continue to ask questions as they arise. Two weeks tomorrow and Japan here we come. 'Come on Wales'.

[Morzine in reply to Eddie49]

Try not do think too much about it as it can take over!it did take me over, but now I rarely think about it.... Just get on with life normally, it’s not a life threatening thing, but the stroke threat thing is real....hence the apixaban...

Enjoy your flight and the rugby!!

Sue

[pinkshell]

Unless you are prepared to risk a stroke which could be catastrophic at worst or mild which might make little difference to your lifestyle I would definitely say YES to apixaiban. I was put on it after a mild stroke and finding I had Afib - which I didn't realise, having put it down the fluttering to too much exertion in the garden when under-hydrated or stress. I have not looked back since starting to take it Why risk a stroke? It's a 'no brainer', as they say, to me. Enjoy Japan and feel safe knowing you are on the appropriate medication.

[Eddie49 in reply to pinkshell]

Thanks pinkshell. Much appreciated.

[canadiananna]

I would only add that keep a record of when you started on apixaban. be aware of any changes in your body like muscle pain or fatigue. There are many people - I am one - who are having side effects from this drug, but the Dr will say you just have to put up with it - or else risk a stroke. There is another post on this site that gave some links of some very good reading material.

[Eddie49 in reply to canadiananna]

Yes, i think that is wise to keep a record to feed back to the G.P. Problem is - what do you do about side effects? Come off Apixaban and take your chances or, as you say, put up with it. That's the scary bit.

[JaneFinn in reply to Eddie49]

Hi Eddie, sorry I’m late to this thread (having been early to your other one!).

Just wanted to say that there’s plenty of people on here who have found they have side effects on one DOAC (eg Apixaban or Rivaroxaban etc), so have been swapped to one of the others and been fine. Some versions just seem to suit different people more. I understand that it’s rare (but it can happen of course) that someone tries them all and finds that none are suitable.

It takes a bit of time to settle into new meds though - I contacted my GP when I had some initial side effects, and he said give it a couple of weeks. Mine settled fine during the second week. I realise this is not great timing for you though, with your trip coming up. Fingers crossed for you xx

[Eddie49 in reply to JaneFinn]

Nice to hear from you again Jane. I rang the GP who told me to stop the Apixaban for a few days to see if that is what is causing side effects. I have an appointment tomorrow to discuss this with the practice pharmacist. Yes the timing could have been better because I think the stress and tension of the coming trip, as we are not experienced travellers, is not helping. In reality I would prefer to take the medication when we get back from Japan, but of course I know that I am putting myself at risk. I asked the GP if it is possible to take 2.5 mg x 2 per day rather than 5 mg x 2 but she was not that keen on that idea. I will see what the pharmacist says tomorrow and feed back. Thanks again, I really appreciate your and everyone else's input. Eddie.

[JaneFinn in reply to Eddie49]

Oh I’m sorry to hear it’s all so complicated 😕 It’s the timing of the holiday that puts extra pressure on it all, isn’t it - I feel for you so much. And for your wife too!

I remember the sheer all-consuming stress I went through over the anticoagulation issue (I hadn’t found this forum at that time, had no one to discuss it with, and was SO scared of the potential side effects). I wouldn’t be wanting to make that decision under time pressure of a big holiday, with significant travelling etc.

I am grateful that my dilemma was resolved by my wonderful GP who just wouldn’t let me get away with holding off taking anticoagulation. He had had a patient recently suffer a devastating stroke after deciding to delay anticoagulation, so he kept booking me appointments and patiently repeating how high my stroke risk was, and how I needed to take them. And then when I started them and panicked because of pains and lightheadedness, he told me to push through and these would pass etc. (Thankfully for me they did.)

Interesting idea of yours about starting at the lower dose of apixaban - easing yourself into it and increasing to full dose when you don’t have side effects (or you can tolerate them). To me, a total non medic(!) that definitely sounds worth discussing again, if you find your side effects have disappeared off the Apixaban. There are some people who have to be on the lower dose anyway. Unless you’re very light in weight, you won’t be as fully anticoagulated, of course, but to my non medical mind it sounds better than not at all?!

I really hope you get a knowledgable and helpful pharmacist tomorrow. Do let us know what s/he says. And most of all, both now and whatever you decide to do, try to keep the stress levels down as low as you possibly can. Way easier said than done, I know. But it’ll help in every way. I do plenty of relaxing breathing exercises, and shoulder rolls and letting go of the tension xx

[Eddie49 in reply to JaneFinn]

Thanks Jane. That's exactly what I was thinking. Perhaps I should put it up as a topic to see what others think?

[JaneFinn in reply to Eddie49]

No harm giving it a go! My guess is that it’ll be rare to find anyone who has done that -but it’d be interesting to get opinions, and also see how many people are on the lower dose for one reason or another.

[Desanthony]

I still drink a small amount of wine every evening even whilst on apixaban, and occasionally drink a GnT and drank the usual at a recent wedding. Wine and champers and a pint of the black stuff but not excessive. The worst thing for me is that I can no longer take NSAID's and I have chronic neck and back pain. The pain used to be kept under control with diclofenac suppositories - and to-proxamol tablets but both these have been discontinued for men over 65 as they can cause heart problems - did that cause my AF - I had been off those medications for years but I suppose they could but wish I could take something like that now or any anti-inflammatory. Anyway, enjoy your time in Japan and give Wales a shout from us back here in West Wales.

[Eddie49 in reply to Desanthony]

Thanks for that. I will give a big shout and think of you when Wales touch down. Cheers.

[dedeottie]

And a big shout from us in South Wales too. Enjoy Japan. X

[Eddie49 in reply to dedeottie]

Will do. Thanks.