Renault42 months ago

Apixiban

Renault42 months ago

Hi I too have seen the article and like you wonder what others both think and know

BobDVolunteer2 months ago

Everything is about risk and reward. Yes if a thousand people took anticoagulants one or two may have bleeds followimg injury. (Anticoagulants do not thin blood they slow down clotting but this misnomer has become sadly common. You won't bleed spontaneously.)

Against that we must remember the many hundreds who will NOT have strokes as a result of taking these useful drugs.

This is why we have CHADSVASC (to work out stroke risk) and HASBLED which is a list of things to consider before issuing anticoagulants.

On balance I think this is just selling newspapers as really it has nothing to do with our problems.

Sambaqui in reply to BobD2 months ago

Thanks, Bob. I agree about selling newspapers. I've been thinking a bit more about the distinction between stroke risk and bleed risk. For those of us with AF, a stroke would be a direct result of the increased risk brought about by the condition. A bleed, though, would be an indirect result of an incident inside the body or one brought about by outside circumstances. To know the size of the risk, I guess the number of people who have serious bleeds and are on anti-coagulants might be compared to the number who have similar experiences but are not.

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BobDVolunteer in reply to Sambaqui2 months ago

You can find some of this information on our website AFA

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Drounding in reply to BobD2 months ago

"...On balance I think this is just selling newspapers as really it has nothing to do with our problems...."

Agreed - another attention grabbing headline. There is of course no mention of COVID iin the headline itself to give context..

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TheProf in reply to Drounding2 months ago

The first word in the headline is Covid - and the rest of the article makes it clear that the study was about post-hospitalisation patients.

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Drounding in reply to TheProf2 months ago

You're right TheProf. I guess I was blinded by what my mind was thinking rather than what my eyes were seeing.

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Karendeena in reply to BobD2 months ago

Agree BobD, never listen to the way the media expands and exaggerates the truth. Seems they don't even know that Apixaban does not thin the blood, anything to sell a story

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Buffafly2 months ago

It’s also on the bbc website. Bearing in mind those people tested were very ill anyway and may have had comorbities I wouldn’t worry too much about it.

mav72 months ago

theguardian.com/world/2022/...

Above is link if it will work.

My opinion of the article is that it states Apixaban is needlessly prescribed for Covid patients and (as known) can cause excessive bleeding. Article (in my opinion) does not mean Apixaban does not work but its use for all Covid patients is questionable.

Let me say if a person has AF they should be on an anticoagulant.

Sambaqui in reply to mav72 months ago

Thanks Buffafly and mav7 for your reassurance, and Bob for website recommendation - I did not know of the ORBIT Bleeding Risk Score.

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Mugsy15 in reply to mav72 months ago

If every AF sufferer should be on an anti coagulant, what is the point of the CHADSVASC score?

Or to put it another way, AF sufferers with none of the other risk factors for stroke are not advised to increase their bleed risk by taking ACs.

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mav7 in reply to Mugsy152 months ago

mdcalc.com/calc/801/cha2ds2...

"Every" may not be the best description.

But I would invite you to do a survey of forum members with AF who have a Chads score that does not recommend an anticoagulant.

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Elli86 in reply to mav72 months ago

I’m one 😆 and there are quite a few others to be fair

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mav7 in reply to Elli862 months ago

That's great ! Looking at your bio, you are 37 ? Age is a key factor to not have other qualifying conditions for an anticoagulant recommendation.

You may be the ideal candidate for a maze procedure. Best to you in managing your health.

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kyoom in reply to mav72 months ago

Your reply is right on target.

Anti coagulants are life saving drugs when used appropriately.

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Mugsy15 in reply to kyoom2 months ago

Yes, they are. And 'used appropriately' in the case of AF patients means 'used in the cases of patients with a Chad score of 2 or more who have agreed with their cardiology practitioner that AC therapy is appropriate'.

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belindalore2 months ago

For more info on side effects of Eliquis (apixaban to those of you overseas) you can look on drugs.com. You can find a more detailed list of side effects there. Interactions with other drugs and reviews from other people who have taken it. I am in the USA and it's advertised on TV like so many other pharma drugs and recently the ad was redone to say that Eliquis can cause mild to severe bleeding. The old ad never mentioned bleeding. So things can change over time. Many people don't know but there is such a thing as the 7 year post drug trials watch in which the pharma companies watch for any new side effects from meds. Drug trials are usually short term and don't necessarily show all possible side effects. Long term side effects cannot be known. Why people have to be diligent and pay attention. This is meant to hopefully inform you, not scare you. We are all different. One person may have good luck taking a certain med, but the next person may not.

Best of luck to you.

Sambaqui in reply to belindalore2 months ago

That's useful info regarding drugs.com and the seven year post drug trials. I read that DOACS were first introduced in 2010 so shall look out for the next report in just over a year. Thank you, Belinda, and all the best.

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belindalore in reply to Sambaqui2 months ago

👍

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Singwell2 months ago

Goodness I'd expect more of the Guardian! Nothing like scaremongering to generate a click...

jeffsimon in reply to Singwell2 months ago

That's exactly what I'd expect from that Commie rag-- The Guardian

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TheProf2 months ago

The article was specifically about post-covid treatment after hospitalisation. Presumably they wanted to avoid DVTs and suchlike problems associated with immobility. APixaban after AF is a different matter since AF is a high-risk factor for strokes and apixaban is used to avoid that. I have taken it for 3 years and yes, I bleed more freely, but I know stroke victims too and would wish to avoid that.

Auriculaire in reply to TheProf2 months ago

What they want to try and counter is the hypercoagubility which can be caused by the spike protein of the virus. This is also a feature of vaccine damage in those who have it- it has been seen in autopsies. This hypercoagubility causes lots of microclots throughout the body. They should trial things like nattokinase and lumbrokinase that have clot busting properties without the problems of the clot busting drugs used after strokes. But they won't because these are natural substances so more difficult to patent.

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TheProf2 months ago

theguardian.com/world/2022/...

Silvasava2 months ago

I had a stroke due to Afib and put on Apixaban automatically. My AFib was discovered after investigations into why I had the stroke. I've not had any issues with excessive bleeding despite having a couple of tooth extractions.

JOY2THEWORLD49 in reply to Silvasava2 months ago

Hi

Like you I went to hospital after experiencing a stroke. But I had AF Rapid and Persistent H/R.

But 4 days later whilst having a carotid arteries scan the lass said "I always check thyroids - two for the price of one!

Then I heard "I had better get my boss. You have a shadow on your thyroid".

So 4 mths later the thyroid with 12 lymph nodes were reoved. 3 lymph nodes were infected.

I was Low Risk for recurrence. I was lucky.

Leading up to the stroke, no drugs but a 150 Systolic rate. 3 months ago I was diagnosed with Soft, Systoluic Heart Murmur to add to my list. No ablations because I have an enlarged heart.

But 2 years 3 monthe I am controlled with added CCB Calcium Channel Blocker! I take 1.25mg Bisoprolol at night away from CCB. Diltiazem 120mg.

I no longer have the excessive sweating.

One day yes one day my heart may return to normal electrical response but at night H/R 47 regardless what meds I took.

Please take care. My stroke at 2am was mild. A very sore head. A left frontal lobe Embolic - Ischaemic Stroke.

What about you? Strokewise?

cheri JOY. 73. (NZ)

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Silvasava in reply to JOY2THEWORLD492 months ago

Mine was an ischaemic stroke, luckily I was able to get to the hospital withing the 4 hour window for it to be thrombolised with no after effects. My AFib was discovered during the tests following. Mine is rythym not rate and TBH I think I've had it al l my life! I also have DCM due to radiation treatment so no option for any surgical intervention but with the cocktail of meds I am functioning pretty well. Not to the level I was but still able to enjoy my life. Lynda 76 x

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JOY2THEWORLD49 in reply to Silvasava2 months ago

Hi

There are two types within the diagnosis of Ischaemic. Embolic or Hae.....

1 simple blood clot lodged in my left frontal lobe. 2am - 530am and by the time I got to hospital in a helicopter on a wet and windy day it was more than 4 hours. But now research shows giving thrombollic meds is not always wise. I see on my notes that I failed the aspirin test. Not sure what that means I could not swallow and I had a drip. Couldn't talk well and right face drop. I cried as I was frightened when I could not let 111 Ambulance know where I lived. But at last the home phone pinpointed where I was.

The helicopter landed in Kerikeri en route as petrol was low.

But awaken with sore head and went back to sleep after bathroom stop, so tired! I live alone with my dog JAZ.

cheri JOY

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Silvasava in reply to JOY2THEWORLD492 months ago

That must have been so scary for you. Have you been able to recover OK? I'm SO lucky, I didn't feel well but I was picking my son up to go to our sailing club. When I got to him I couldn't speak properly so I drove back home despite him wanting to take me. I rang our 111 system and they sent out an ambulance. I particularly remembered the time because of picking up my son. The hospital were horrified that I'd driven, but they swung into action like a well oiled machine, they were brilliant..

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JOY2THEWORLD49 in reply to Silvasava2 months ago

Hi

You were driving?

So yours happened during the day?

Did you get a face drop? I had dropsy in my right hand and

the following day I was desperately trying to get my Jerusalem Iraeli ring off. Fingers swelled.

I remember the speech theray there explaining lessons on the day of arrival. She said sing! and keep talking but the Junior Dr who wrote my discharge notes said I have never had anyone on the ward who was chatting away and looked up her records to see if there was any insanity history. There was not." I rang him up and told he off. How dare he? I explained that the Speech Therapist told me to sing! And Talk!

111 you must be in New Zealand as well.

I was dribbling out the side of my mouth - right.

I was transferred up to Kaitaia on 4th day. Only 4 beds and I was walking around.

After strokerules are "you are not allowed to drive for 6 weeks. Then a locum Dr on top of that said that I had to take a test. This ended up another 6 weeks.

I received 10 out of 10 and I had to pay $65 for it.

Which part of NZ?

Do you have any lasting problems of your stroke?

Are you on anti-co.agulants?

JOY

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Silvasava in reply to JOY2THEWORLD492 months ago

Im in tne UK, I had the stroke at home but didn't realise until I got to my son's and couldn't talk properly. He wanted to drive me back home but I insisted I was fine. I realised I was tending to veer to the right and concentrated on the red car in front of me to stay on the straight and narrow. Luckily I live about 10 minutes from my son but I should never have driven. I spent 2 nights in hospital but that was partly because I was discharged on Christmas Eve (3 years ago this year) I also had speech therapy. 4 days after Christmas I flew to Scotland for 4 days to see the new year in.....talk about madness! I wasn't allowed to drive for 4 weeks, didn't have to take a test here, No lasting issues but it did uncover Afib and DCM so a cocktail of drugs including an anti coagulant. A bit of brain fog sometimes but could be due to age and meds so I'm not going to worry about it!

Lynda

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JOY2THEWORLD49 in reply to Silvasava2 months ago

Hi

Well its not 111 for emergency in UK.

I have forgotten what it is .. 999 perhaps as one of my temporary jobs was accepting complaints for British Telecom. I answered a call. The man had fallen down the stairs and could just reach 999.

I was reprimanded for transferring the call to anbulance.

How is that for assisting this gentleman!

Remember no driving after a stroke for some weeks and a doctor's OK.

JOY. 73. (NZ)

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Silvasava in reply to JOY2THEWORLD492 months ago

Joy, 111 is the NHS line for advice and they will call emergency if necessary. I wasn't aware I had a stroke, I just didn't feel well. After giving my details they called an ambulance. I didn't need my doctors authority to be able to drive as my cardiologist seems to take precedence here on occasions.

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waterlady2 months ago

I have had two operations within four years, last one major spine operation, both times came off apixaban without any problems. Been taking it for 10 years.

Tryfan2 months ago

According to my Dr friends. The biggest risk and danger are brain bleeds. Being careful around, and whenever possible avoiding head injuries.

Fibber222 in reply to Tryfan2 months ago

That follows. When I fainted and cut my head open the first thing done in A & Ecwas a brain scan because I was on an anticoagulant.

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pd632 months ago

Daily Express states worst winter for 50 years is on the way every year, don't believe all u read,offtrack a little just making a point

ozziebob2 months ago

However, for those AF sufferers with lower stroke risks, or no comorbidities, this study is a reminder to me that the future of anticoagulants may be their use as PIPs rather than 24/7.

This HEAL-COVID study referred to Apixaban use both in the acute phase in hospital (apparently successfully), and the later out of hospital phase (reported as unsuccessful).

These 2 different settings seem to have parallels to my experience of AF with an acute phase, and then the longer phase after AF ceases (hopefully).

Relevantly (to me), it brings to mind the study just starting on this exact issue in USA, and reported on recently in the Forum ...

news.northwestern.edu/stori...

With apologies to those Forum members who believe otherwise. Just trying to understand better.

Sambaqui in reply to ozziebob2 months ago

Sounds like that could be an interesting development. Please do post if you hear of any more about the study.

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JOY2THEWORLD49 in reply to ozziebob2 months ago

Hi

I brought to the arrention of you Afers the UK Medical Research place about PIP med as an anti-co.agulant. RADCLIFFE.

I get information as a former nurse and now an interested patient as an AFer.

But it is a break through if a device can alert you of an impending episode of AF. That device is a life-saver.

Being a non taker of drugs except B12 (in the form of pill under tongue, a nugget - Solgar Gold Top) I would stand in line for PIP but sadly my AF is persistent but now controlled.

Interestingly my stroke embolic, was experienced at 2am which awoke me. Earlier in late afternoon I had mown the 2 small lawns with a rest between.

All for less of meds. I have 125-150mg Synthoid early morning daily to keep me alive, 2 heart pills, am and pm, and PRADAXA 110mg twice a day. And B12, Fixonase if necessary 1 squirt each nostril. Polygel x 4 day. Low-fat diet no gall bladder. Now no Johnson & Johnson mesh! No tonsils and ananoids, 1 ovary, rest gone! Oh no thyroid or 12 right lymph nodes.

Don't think there is much more they can take! Ha ha.

cheri JOY 73 (NZ)

Reducing PRADAXA gave me back my healthy working natural teeth. 150mg x 2 day I couldnt eat my wheaten crackers or almonds.

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joliet21 in reply to ozziebob2 months ago

I already use Apixaban as PIP (for 2 weeks) after an infrequent AF episode as suggested by my EP two years ago after my ablation.

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Tapanac2 months ago

I’m on apixaban and I’ve had three very bad falls. Two of them crashing my head as well as other parts of my body. The second time i had a brain haemorrhage, but i was given the reversal drug, stopped apixaban for 2 weeks and it healed

Don’t worry I think the media sometimes are scaremongers.

Anticoagulants -v- a stroke, no contest in my view

All the best

Pat

mrgwair567 in reply to Tapanac2 months ago

That’s very reassuring!

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ozziebob in reply to Tapanac2 months ago

My concerns are more with chronic brain or other bleeds, not with an acute crisis/accident such as you described.

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Tapanac in reply to ozziebob2 months ago

yes I understand that, but unless you have a tendency in that way, although not a doctor, I would assume that an anticoagulant would not CAUSE a brain bleed.

Should anyone have an aneurism it wouldn’t be “caused” by the anti coagulant as it would be an unfortunate something that could happen to anyone at any time. As I said before there are always the reversal drugs which I had and that is why you should always go to the hospital should you bang your head

Try not to worry. Easier said than done I know

Pat x

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ozziebob in reply to Tapanac2 months ago

Thanks for your considered reply. If you read my Bio you will see why I am troubled by 24/7 anticoagulation.

Not only that, I have read medical research results that explicitly state that the brain bleeds observed would have been fatal if the person had been anticoagulated at the time.

Also, I live alone, and may well enter a condition at home where I am unable to help myself, or even make a phonecall, let alone get to a hospital for a reversal agent.

But good advice, I don't worry, it is what it is.

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Tapanac in reply to ozziebob2 months ago

oh you are brave and I think living alone or being the only person responsible is a burden in itself

You’re right it is what it is. I had brain tumour surgery a couple of years ago and although I had to stop my apixaban two days before snd for a week afterwards I tried to be philosophical as I had no choice, but it was hard and my husband didn’t have his mild dementia then.

I do wish you the very best and although living alone which means you can’t easily voice what you’re feeling at the moment, I and many others on this forum are always willing to listen and try to help

All the best

Pat

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ozziebob in reply to Tapanac2 months ago

Thanks Pat for your kind words. Unfortunately for me, your Bio doesn't reveal much about your medical situation, so I cannot really appreciate your struggles, other than the brain tumour and brain haemorrhage you casually mentioned just now. (What !!!!!)

"Such is life", as the title of a famous Australian novel goes.

The only advice I can offer is please stop living such an adventurous life that leads you to repeatedly "falling over" and banging your head. "Naughty girl".

Keep smiling!

bob

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Tapanac in reply to ozziebob2 months ago

ha ha and since afib I don’t even get drunk any more!! As for naughty girl it should be silly old woman!!

You take care

Xxxx

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Janey1955 in reply to ozziebob2 months ago

yes I live alone and it worries me too. Just have to hope nothing happens

Jane

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ozziebob in reply to Janey19552 months ago

A neurologist suggested to me that a possible cause for my brain bleed might have been "straining on the toilet".

So I suggest if neither of us go near toilets for the remainder of our lives, and we'd be home free.

Remain positive,

bob

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mrgwair567 in reply to ozziebob2 months ago

🤣😂🤣!

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JOY2THEWORLD49 in reply to Tapanac2 months ago

Hi

I had a fall and banged my head.

I have a home alarm so I rung it to allow St John Ambulance team to check me out.

Didn't worry that I was on PRADAXA.

The national cardiac specialist was mostly concerned about NOT taking Pradaxa that anything else as. for some reason there was a gap is my prescription of PRADAXA even though I picked it up from chemist.

Here in New Zealand if one gets COVID that we AFs shouldn't take the

drug which lessens the symptoms. I stay double masked. NZ's total of new COVID patients are creeping up. Some are dying. Latest figures 27,000 new cases in one week.

cheri JOY. 73. (NZ)

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Tapanac in reply to JOY2THEWORLD492 months ago

oh goodness you stay well. yes important to take anticoagulants if you are able to

Covid is awful. My husband didn’t even know he had it except for the positive test, but I was so ill really bad headache which nothing would help shivers hot and cold sore throat kidneys painful ached all over. Then I got covid induced lung/chest infection then covid induced again pneumonia. Then it managed to mess up my afib. Still don’t feel great or well. Though an old lady now certainly don’t feel like dancing on the tables!!

So you keep well and away from crowds and follow the rules

All the best

Pat x

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JOY2THEWORLD49 in reply to Tapanac2 months ago

Oh Heck.

Thanx for your reply.

Went on bus yesterday. Small low top Mitsubishi Light Ace.

No one wearing a mask. I was double masked. Off to hospital 40kms away.

Hope our usual bus comes back.

No I dont want Covid ( 4 jabs Pzifer) or Flu (no injection).

Told to stop Nifun at 6 mths for prevention urine infection (had TVT partially removed. He said it could cause pneumonia.

Yes I do have a dog JAZ.

Life is an up and down with AF and trying to evade bugs.

Brain fog is something else. I write notes and more notes.

Dementia is common as we overflow information. Ha ha.

cheri JOY

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Countrydweller22 months ago

Just read this article. It says the AstraZeneca covid vaccination caused a deep vein clot in her leg. A week after stopping Apixaban she died. The clot had travelled to her lung.

Peacefulneedshelp in reply to Countrydweller22 months ago

my nephew is dealing with this same problem. They have him on Warfarin. It’s taking a long time to dissolve all the clots

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Countrydweller2 in reply to Peacefulneedshelp2 months ago

Are they actually dissolving? We are led to believe these meds are miracle workers but that doesn't sound so good.

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Peacefulneedshelp in reply to Countrydweller22 months ago

Yes, they are but it had taken a long time and he had a lot of them. None went to lungs or brain. He never had Covid but only the vaccine, so it makes one wonder what is going on.

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confused712 months ago

Saw this feeling aprehensive

MWIC2 months ago

it’s my understanding that with AF there is an increased risk of blood pooling in the chambers of the heart which leads to an increased risk of clots forming - Apixaban reduces the risk of this clotting but doesn’t necessarily increase the risk of a bleed. Also worth remembering that strokes can come about due to clots or a bleed - Have to say when I feel my heart dancing around I’m grateful for the Apixaban in my system - please put me right if my thinking is flawed

oscarfox492 months ago

My conclusion after finally reading the article today is that as the advantage of taking Apixaban is only 0.9% in being rehospitalised after Covid (compared to taking nothing), then NICE quite rightly are no longer recommending it as any kind of effective post Covid treatment. Given the inflated risk of major bleeding and accidents which arise from Apixaban, about which we should already know... and which are outweighed many times by the reduction of incidence of stroke and so on, it makes absolute sense to not to recommend something which in the Covid case improves the situation by less than 1%, statistically speaking, undetectable and of no signficance at all.

JOY2THEWORLD492 months ago

Hi

I read that Apixaban is the safest but more expensive anti-co.agulant.

But New Zealand does not offer it.

I chose PRADAXA from the few I was offered by The Dr on Stroke Ward.

Because it was twice a day (I had other pills to take at that time. Also it had an antidote which was readily available.

I was prescribed 110mg x twice a day.

4 days later I was transferred closer to home.

4 days there amd discharged on 150mg x twice a day. It wasn't until 2 years 3 months later I found this out and under Locum's protest I changed back to 110mg x twice a day. I was 70 when I had the stroke with clear carotid arteries. So I was going on 73 years when I changed back. This stopped my natural teeth from being too weak to crunch down on almonds etc. Also I had an influx in energy.

Is it a false direction to change you from Apixaban to a cheaper drug e.g. Endo....

PRADAXA dissolves better in the stomach with acid so I take mine with fruit or fruit juice.

Keeping checking it out if you are rattled by this Sambaqui.

Cheri. JOY. 73. (NZ)

Dadtoalad232 months ago

I hate taking Apixiban !! I’m 46 and have a CHADvasc score of 0 my EP told me my bleed risk is higher than my stroke risk and to stop the Apixiban. But from reading forums and researching I’ve become frightened of having a stroke and have kept taking the Apixiban.

Our health care system in the uk provides very little decent explanation of risks or benefits. In my mind a gastro bleed would be better than a stroke but a brain haemorrhage would be worse. Also people do bleed to death from gastric bleeds.

I’m in persistent Afib and probably had paroxysmal afib for 5-6 maybe more years without being diagnosed. I want better information and I want to not take these medications for the rest of my life ! Taking these blood thinners for the next 20 years seems unlikely to be healthy.

The risks I’ve looked up are this I have a 1 in 100 risk of stroke annually and I have a 1 in 345 risk of a major bleed on anticoagulants. What kind of choice is that !!! As I’ve said before mini maze atrial clip or watchman or whatever I’d have it tomorrow.

Ps. Hands up to any of you who aren’t on an anticoagulant ?? Either by choice or by advice via CHADvasc2 score ?

Mugsy15 in reply to Dadtoalad232 months ago

🙋‍♂️

I'm not on ACs because my Chad score is 0. It's a simple formula for deciding risk versus benefit and I choose to be guided by it.

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Dadtoalad23 in reply to Mugsy152 months ago

thanks mugsy … are you persistent or paroxysmal ?

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Mugsy15 in reply to Dadtoalad232 months ago

I was parox for a year or two then persistent for best part of a year, which made me feel lousy; I spent every day wishing I was in bed. I was cardioverted, which kept me feeling great and in NSR for over a year until my ablation. That was almost a year ago and as far as I'm aware I haven't been in AF since then. I do have a high burden of ectopics but can live with that as long as I feel reasonably well.

I'm 61. When I'm 65 my Chad score will go to 1. I'll consider my condition at that point. If it hasn't worsened and the criteria for assessing stroke risk hasn't changed, I still won't take ac.

Many on this forum disregard the Chad score and take ac's because of their fear of the devastating effects of stroke. I do understand that and if the time comes I'll jump on board, but as things stand I have none of the recognised risk factors , so in my case the risk outweighs the benefit.

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Dadtoalad23 in reply to Mugsy152 months ago

thanks for that reply. Pretty much sums up everything I wanted to know. Just had a CT angiogram so will see what that says before I make a decision on the anticoagulants. Nice to hear your cardioversion actually worked for a year. I don’t hear that much from persistent Afibbers. And that your ablation has kept you in NSR you sound like one of the lucky ones. Thanks again.

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Mugsy15 in reply to Dadtoalad232 months ago

The cardioversion kept me in NSR for the year I had to wait for my ablation, and I'm sure would've done so well beyond that. I decided to 'mend the roof while the sun is shining'; to have the ablation while I was in sinus rhythm, which gives the best chance of a successful outcome. That means I'll never know how long the cardioversion would have worked, but it certainly did the trick for me.

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Dadtoalad23 in reply to Mugsy152 months ago

nice to hear something positive for a change !

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Dadtoalad232 months ago

also from the article at the bottom there was this correction.

This article was amended on 28 November 2022. The guidelines drawn up by the National Institute for Health and Care Excellence, and the comments included from Prof Charlotte Summers regarding these guidelines, both relate to blood-thinning therapy in general, rather than to Apixaban specifically as an earlier version indicated. This has been corrected.