Apixaban: I have PAF and it’s been... - AF Association

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Apixaban

kalgs profile image

I have PAF and it’s been recommended I start Apixaban. I’m worried about possible bleeds but also by the recommendation to give up riding my motorcycle and any other activities that might cause injury . Also been told not to drink alcohol.I am very active around home and often using chainsaw and working up ladders. I am not sure the risks outweigh the benefits ??

47 Replies

Would not worry to much about it mate , I have been on it six years still do everything

kalgs profile image
kalgs in reply to maund

Thanks

Ellie-Ann profile image
Ellie-Ann in reply to maund

I’ve been on Apaxiban for only four months and have had similar worries re bleeds. After falling on my front down in the woods and a recent couple of sports massages I’ve gained more confidence! If I get a good bang on the head I’ll go to A and E otherwise I’ll just get on with it, good idea to have a small container with plasters etc though in your bag. Good luck. Keep off the alcohol…you’ll find you’ll be fine. Sparkling water and a slice of lemon hits the spot. Ellie Ann.

kalgs profile image
kalgs in reply to Ellie-Ann

Thanks

Sounds a bit extreme! Any activity can cause injury! I can appreciate the risks but can also understand you not wanting to just stop living your life! However, l would say, don't be tempted NOT to take Apixaban. Before I was taking any anti coag I got a blood clot during an episode. Luckily (not a word I like!) it went down my arm or the outcome could have been very different.Take extra care and keep safe.

kalgs profile image
kalgs in reply to Wightbaby

Thanks

It’s not unusual for people to have similar concerns when prescribed an anticoagulant and I guess it’s always sensible to be more careful and wear protective clothing when necessary. However, I too have been taking Apixaban for 6 years and can honestly say I have not experienced any changes when dealing with normal cuts and scrapes etc.

Do the risks outweigh the benefits. If you have a stroke and the pundits say that if you have AF, you are 5 times more likely to, one things for sure, all the activities you mentioned plus many more, would be kicked into touch.

Of course it has to be a personal decision, but speaking only for myself, I would not let taking Apixaban prevent me from doing the things I want to do but I am absolutely scared of the consequences for me and my family should I have a stroke. Regarding alcohol, it’s best avoided by anyone who has AF but some say that if taken in moderation and it doesn’t impact on AF, then the occasional tipple is fine.

kalgs profile image
kalgs in reply to FlapJack

Thanks

Wightbaby profile image
Wightbaby in reply to FlapJack

Total agreement on that, Flapjack!

It’s your choice. If you had a chainsaw or motor bike serious injury you will bleed out faster on anticoagulant because if help arrived fast enough, they would have more problems stopping the bleed. But that might happen anyway. Some may say don’t risk it others may go ahead regardless.

My advice is don’t have an accident and if you do go ahead with higher risk activities - be extra, extra careful.

In my experience of taking Apixaban it doesn’t make minor injuries more difficult - just takes longer to stem some bleeds.

On the other hand the protection it may offer you against stroke in your everyday life has been demonstrated to be efficacious. I worry far more about stroke than the possible catastrophic bleeds from an accident.

I’ll end where I started - it’s your life, your choices.

kalgs profile image
kalgs in reply to CDreamer

Thanks

PS - You may find it increases your insurance when you declare you are on anticoagulants?

kalgs profile image
kalgs in reply to CDreamer

Thanks

BobD profile image
BobDVolunteer

Nonsense. Carry on as you are apart for the alcohol which has nothing to do with anticoagulation. After sixteen years on warfarin building race car engines and machining stuff plus log cutting (chainsaw ) I'm still here and never had a problem. Bleed risk is there especially if you had a serious head injury but greatly over stated and any serious bleed would probably have been serious even without anticoagulation.

kalgs profile image
kalgs in reply to BobD

Thanks

kalgs profile image
kalgs in reply to BobD

Why the alcohol. I don’t drink a lot but like a glass of wine

CDreamer profile image
CDreamer in reply to kalgs

Because even taken in small quantities, over time it’s known to cause scarring within the heart = more chance of AF.

kalgs profile image
kalgs in reply to CDreamer

Right thanks

Karendeena profile image
Karendeena in reply to kalgs

I was told I can drink in moderation and that's a guide from my EP who is a top Professor

Hello Kalgs, Sounds like you don’t need wrapping in cottonwool. I’ve been on anticoagulants about 2.5yrs and the concern gets less once you’ve got past the first couple of bumps & scrapes - which will happen…. It’s not a big issue really, I just now have good stocks of plasters & dressings for if I need them. As it happens I’m at my brothers house building today, so got some spray coagulant & liquid dressing in my toolkit just incase - not tried them before. Will review them if I use them. I’d be concerned about stroke risk without anticoagulants though.

Good luck in your decision.

Steve.

kalgs profile image
kalgs in reply to Shrek1974

Thanks

Shrek1974 profile image
Shrek1974 in reply to kalgs

Well no cuts to report but there’s always tomorrow….. After the graft I’ve enjoyed about 5 pints again though & no bother whatsoever! Completely de-stressed & chilled after a rare day with my brother. Don’t think my stress induced (I’m quite certain) AF can bite me here.

There's stuff you can buy to carry in case of emergency, the military have them. If I remember correctly it's like a pad you apply to a wound. There are smaller scale equivalents too, like 'bleedease'., I think it's called. And obviously carry your apaxban card and wear proper chainsawing protective clothing.

Others have also said. Like you I worried for the first couple of weeks. But then got on with it. I dont any longer ride motorcycles but ride a bike. Climb ladders, mountains. Live life as normal as I can.The main thing to be aware of is bangs to the head. The rest, you might bleed a little more. Bruise more easily, I do. For bruising I use Arnica ointment, find it efficacious. Take Apixaban and enjoy life. You dont want a stroke.

kalgs profile image
kalgs in reply to Tryfan

Thanks

Hi, taking Apixaban doesn't mean stop living. I went through this discussion with my Cardiologist and that's what he told me .I regularly go for a few pints of beer 4 or 5, beer doesn't trigger my AF but stress does.

So don't get stressed and enjoy life do the things in moderation and learn what triggers your AF and what doesn't. I'm going in for my Cryo Balloon Ablation tomorrow really looking forward to having it done and then getting on with life. Good luck to you.

kalgs profile image
kalgs in reply to Visacrem

Thanks . So beer is ok. I was told alcohol can cause a bleed due to the anticoagulants ?

Karendeena profile image
Karendeena in reply to kalgs

Not heard that one although too much alcohol I believe can thin the blood!

kalgs profile image
kalgs in reply to Visacrem

Good luck

kalgs I'm a hand tool woodworker and frequently cut my hands. They heal just normally. So don't worry too much about it.

Having said that, a bang on the head can be quite damaging, and the older you get the worse the damage. It seems that our brains shrink a little as we age, and this stretches the blood vessels feeding the brain so they get more susceptible to breakages. Coupled to that there is more room around the brain for it move. A subdural bleed can be as devastating as a stroke. You can see why they made the recommendation about the motorcycling. If you are willing to accept the risks of motorcycling anyway, then I'd suggest as BobD says, just carry on.

I do wear a medical alert bracelet when I'm away from home. I like the very cheap silicone rubber ones you can get from your favourite online sellers.

kalgs profile image
kalgs in reply to momist

Many thanks

Hi kalgs,I appreciate the concern regarding bleeds however be aware there is now a specific reversal agent approved for Apixaban called Andexanet. The NICE website describes it thus;-

"Andexanet alfa (Ondexxya®) is a specific reversal agent indicated for adults treated with a direct factor Xa (FXa) inhibitor (apixaban or rivaroxaban) when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding."

Worth noting should the worse ever happen!

Good luck

kalgs profile image
kalgs in reply to mhoam

Thanks . Of course it needs to be close enough and I guess it’s not in every hospital?

Sorry, no idea how widely it is available, it's not long been approved. I have written the name of the "reversal agent" on the Anti-Coag card I carry in my wallet, just in case.Hopefully will never need it :-)

Hi, sorry to mislead you kalgs, Andexanet is NOT yet fully approved, still in trials :-(

Karendeena profile image
Karendeena in reply to mhoam

There is a reversal for apixaban already approved not sure about the one you are referring to

mhoam profile image
mhoam in reply to Karendeena

Hi karendeena, I have no medical qualifications, here in the UK the use of treatments is managed by NICE and this link gives the current situation with regards to the use of Andexanet (branded Ondexxya) for reversing the effects of Apixaban and Rivaroxaban:-

nice.org.uk/guidance/ta697/...

There is a lot of detailed information and discussion about this situation on that site at;-

nice.org.uk/guidance/ta697/...

Of course the position may be different elsewhere, i.e in the USA

cheers

I have been on Apixaban for many years. Apart from an increased number of nosebleeds (which was fixed with a cauterization), I have had no issues. I carry the Apixaban card in my wallet with my ID. Cheers........

kalgs profile image
kalgs in reply to Gladstone001

Thanks

Sounds like my story. I had PAF and every trip to the cardiologist they lobbied for me to go on apixaban. I didn't. In my case the risk of stroke would have been reduced from about 4.5% to 1.5% by going on the thinner. I'm a numbers guy--and this change in risk didn't sway me. I remained on the "pill in the pocket" treatment routine (metoprolol with flecainide) for when I had an episode--but never went on the apixaban. I had PAF for about 4 years, an episode about every 1-2 months. Then early this year my PAF started to increase in frequency to about every 1-2 weeks, which increased my stroke risk, made me feel terrible all the time from the medication, and put me in a state of constant anxiety and increased my stroke risk--so I opted for an ablation (PVI).

I had the ablation a little over a month ago. After a couple of weeks of weird beats as my heart began healing and remodeling, things are back to normal. The ironic thing is that after the ablation I have to be on apixaban for 90 days while my heart is healing, because it will throw abnormal beats and there is a risk of clots. I'm back to active around home using my sharp tools and taking other "risks" that might lead to a bleed. I'm conscious of the bleed risk and I am very careful. That's my personal choice--as was the ablation. You have your own personal health choices as well. Good luck and stay healthy!

kalgs profile image
kalgs in reply to seasicksurf

Sounds like me with increased PAF frequency. I’m waiting for ablation at Barts and they want me on apixaban. Before they do the procedure.Good luck with your full recovery

How was the ablation as an “ experience “

?

seasicksurf profile image
seasicksurf in reply to kalgs

to begin, I'm in the US, so what I experienced might be somewhat different than the UK experience. And I know from hospital to hospital things may differ, but here's my summary.First, I was washed, prepped and shaved down under for clean entry for the catheters, then wheeled off to the "cather lab". The left atrial PVI took about 3 hours and the doctor included an "afib flutter line" (ablation scar line) in the right atrium that took about another half hour. He said about 15-20% come back after PVI to have atrial flutter fixed, so he just does the flutter burn line while he has you under and all the catheters into your heart. I had catheter lines in both groin femoral veins and one in the neck, for modeling the heart shape, etc and for the radio frequency line. After I woke up from sedation, I had to stay laying flat for four hours so as not to risk opening up the fragile femoral entry points. I stayed one night in the hospital for observation. The worst of it the first couple days was from the fluid that built up in my chest from sedation and/or the catheter irrigation. I coughed for several days getting the fluid out. I did have a bit of pain in the chest as well for a few days, but nothing real bad. Overall, it has been a steady improvement, first with some weird beats, and then with some real slow beats, but now everything is just fine (after a month). I hope this helps. I was real anxious about the whole thing, but looking back the "experience" was not too bad and definetly worth doing if I remain in normal rhythm. All the best to you kalgs.

I am a keen biker ( pillion only) and have never been told to stop biking after starting Apixaban . Take no notice. You could just as easily bash your head on an open cupboard door and get a subdural haematoma. Life is full of risks. Giving up biking would no doubt seriously damage your QOL.

One possible issue with apixaban you may want to be aware of. When I first started taking it I felt very dizzy with a tendency to lurch about a bit. It has got somewhat better over time and nobody else has mentioned it so it may just be me. But not good if you are shinning up ladders.

kalgs profile image
kalgs in reply to dunestar

Thanks

Hi kalgs I was in a similar position and had to give up my beloved horseriding, small price to pay when you consider you have a 5 times higher risk of a stroke. I have been told that I can have a drink as long as I'm sensible and this came from my EP and he prescribed the drugs

Weird? I carry on as normal and have had no problems with bleeds. Up and down ladders, pruning rose bushes, sawing wood and so on and so on. who on earth told you this? I do not bleed any more or any longer than I did before.

As far as the alcohol is concerned if alcohol is a trigger for your AF then you should avoid it. For me it isn't and I was told I could partake of a small amount now and again - but that's what I always did as I have never been a big drinker. If you have a cardioversion (CV) ablation or any other procedure for your AF then it would be advisable to not drink alcohol for a while afterwards to give your heart time to settle down.

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