Apixaban and normal INR and Prothrombin Time - Problem?

[jusjay9]

I take apixaban (2x5mg daily) for permanent AFib. (It's one of seven prescription drugs I take daily for a variety of ailments). In about a week I am scheduled to have a scan of a lump on my thyroid, possibly followed by a needle biopsy. I was required to have several blood tests before going to the appointment. Results all showed values in normal ranges and usually that would, of course, be very pleasing. However I am worried that my INR (precisely 1.0) and Prothrombin Time (10.45sec) are normal. Should not one of these measures be affected by the apixaban? If not, how does one know that the apixaban is protecting against blood clots?

Also, can anyone advise on my concern about the Patient Information Leaflet advising that I stop taking apixaban "1 day before the procedure." I am quite anxious about missing even a single dose of apixaban, which I take at 11 am and 11 pm every day. Would I be ok to take the normal 11 pm dose the night before the procedure and the next dose immediately after the procedure (which is scheduled for 11:10 am? I fear both excessive bleeding from taking apixaban too close to the time of the biopsy (which won't be done if the scan looks ok) and the risk ofastrome from missing a dose!

Lastly, please accept thanks in advance to any who reply to this post -- my typing is impaired by various other ailments and very burdensome, so I may not manage individual thank-yous if there are lots of replies.

[CDreamer]

Apixaban works very differently to Wafarin so INR rates are immaterial to the efficacy of Apixaban, which stops the clotting process at a much earlier rate. Wafarin is a VitK inhibitor whilst Apixaban is FactorX inhibitor. There are many various stages in the clotting process. I suppose I am intrigued as a result as to why you had an INR test in the first place?

Apixaban has been well tested and shown to be effective. I have had various procedures and not stopped my Apixaban the day before but told to just miss the dose the morning of the procedure but you will be appropriately advised by the person doing the procedure.

Apixaban has a short half life of 12 hours and I had a pacemaker revision which required a lot of digging around in my chest to remove and replace the device and replace the leads to my heart which took 3 hours and as I was conscious for the whole of the procedure I can honestly say - there was very little bleeding and none at all after closure, mostly due to the excellence and skill of the EP performing the procedure.

Apixaban nor any other anticoagulant, does not cause bleeding but may prolong the bleeding time but unless you suffer major trauma or internal bleed which would be difficult to stop anyway, it should not make a noticeable difference.

Please consult your doctor as to timings as to when you should stop your anticoagulant, different hospitals and doctors have different requirements but as Apixaban as a half life of 12 hours, I would imagine that it will depend upon the timing of your procedure as there will be some protection for more than 12 hours as it will take longer for all of the drug to clear your system. I felt quite safe being in hospital as the staff all knew my conditions and I have several and I was aware, because I heard them say so, that they had bridging anticoagulants on hand in the very unlikely event of my needing one.

I hope that has gone some way to reassure you, going in for any procedure gets the worry lines working overtime and a biopsy the very worst so I think it quite normal to be anxious and the best antidote I know is knowledge so ask your doctor to talk things through and put your questions to them. A very kind doctor who was doing a quite complicated procedure once said to me - you think you have stuff to worry about, believe you me I have a lot more so I’ll do the worrying for both of us - said in a very kind way which I found very reassuring as we had talked through all of the possible complications and what would happen if any one them occurred.

With very best wishes, take care.

[jusjay9]

Thanks so much! Very helpful and reassuring. No idea why they did an INR and was surprised to see it -- haven't had one since I moved from warfarin to apixaban several years ago.

[Hidden]

Nothing to add regarding INR but thyroid problems can be a significant contributor to AF problems so this maybe something you should discuss with your doctors. Has “permanent” AF been diagnosed because all attempts to return to normal sinus rhythm such as a cardioversion have been tried and failed. I ask because there is a difference between persistent and permanent AF. Maybe this is something to consider later after you thyroid treatment. Try not to worry about missing an Apixaban dose, this is normal for many procedures and is really not a problem. Good luck with your treatment.

[bantam12]

I have had 1 major operation and 1 invasive procedure in the last 3 months so had to stop taking my Apixaban for 5 days on each occasion, didn't cause any problems at all.

[baba]

You should take the advice of the team doing the procedure and discuss any concerns with them, including precise timing of anticoagulant before and after biopsy.

The thyroid is a very vascular organ with potential to bleed. Having said that I've had a couple of thyroid biopsies without problems. I think I had to stop Apixaban three days before.

Good luck with the scan, you may not need the biopsy.

[concup]

You take Apixaban 365 days a year and as my Dr says missing a day should not be an issue,and if your medical advice says miss a day then just do it,

[Yasmel]

I had a procedure earlier this year consultant told me to stop Apixaban two days before everything was fine.