abdominal haematoma and apixaban (persistent Af)

[Sentipede]

ended up in a and e with suspected appendicitis in Sunday but it turned out to be an abdominal wall haematoma, probably caused by violent coughing and being on apixiban. Was told to stop taking apixiban for 14 days and to go back if pain worsens or bruising appeared. When I spoke to GP he agreed with 14 days but also referred me for a scan that will probably take several weeks for appointment! Went back to a and e last night because of bruising- pain less but more widespread. After blood tests ( no scan) was told to go home but this time a different consultant ( I didn’t actually see him!!) recommended resuming apixaban after another 48 hours. Am confused and worried as without any scans to check if bleeding has stopped, resuming apixiban could make the bleed worse. I know they need to weigh up the risk of bleeding against the risk of stroke, but the different opinions are quite worrying. Has anyone had a similar experience? If so how long, was anti coagulation stopped? Thanks

[jeanjeannie50]

Well you've had two medically qualified people saying stop your apixaban for 14 days and another consultant (who didn't even bother to see you) saying start again in 48hrs. I know whose advice I'd follow, but the choice has to be yours.

[Sentipede in reply to jeanjeannie50]

Thanks for your reply. The first consultant who recommended 14 days didn’t actually see me either! They just relayed their opinions through a and e doctor. But I am inclined to wait longer to give it time to heal and not risk more bleeding. Hoping to speak to GP later today.

[mav7]

ncbi.nlm.nih.gov/books/NBK5....

I googled abdominal hematoma having not heard of the condition. Above is info sheet you may find of interest.

I would recommend you also consult with the doctor who primarily is treating you for afib. Perhaps he/she can expedite the process for an ultrasound and bring clarity when to resume apixiban. Even a phone consult for this important event.

Best to you !

[Sentipede in reply to mav7]

Thank you for your advice. Have looked at the information you provided. Unfortunately chances of getting in touch with cardiologist are very slim. His referral for a 72 hour ECG last year to confirm A Fib took almost 6 months and multiple phone calls didn’t speed things up! NHS just seems to be overwhelmed at the moment.

[mav7 in reply to Sentipede]

Depending on your symptoms, I would not hesitate going to A&E.

Best to you in managing your health.

[Sentipede in reply to mav7]

Thank you. No will definitely go back if symptoms get worse

[pusillanimous]

I'm appalled that you have to wait so long for a scan in your situation, it is unbelievable!

[Sentipede in reply to pusillanimous]

Thank you. I did have an initial ct scan that showed the haematoma. Now I have done more research, it seems commonplace nowadays to leave it for a while to hopefully resolve itself. Just a bit worrying being off the anticoagulant!

[Singwell]

I think, if you're worried, I'd go back and dig your heels in. You've a right to be concerned about abdominal haemorrhage. Go in during the day and get your scan done.

[Sentipede in reply to Singwell]

Thank you for your reply.

[Ppiman]

I think we all worry about haemorrhages forming when taking anticoagulants. I had a quick look at Dr Google and found mostly that abdominal haematomas are commoner in older people on anticoagulants but that conservative treatment (i.e. what you have been given) is the usual way forward and that is mostly entirely successful with the haematoma resolving itself naturally.

Ideally, and with a different and properly functioning health service, you'd have seen a specialist and had a more thorough investigation, but it would seem that the doctors have acted correctly and have treated you safely. The differing advice suggests only that there is no straight answer to the problem only that based on an individual doctors' personal knowledge and experiences.

Steve

[Sentipede in reply to Ppiman]

Thanks Steve. Now I have done a bit more research and stopped worrying so much that is the conclusion I have come to.The initial surgical team that diagnosed it said they would transfer me to a larger hospital for treatment and regular scans to check progress ( apparently that is what used to happen before the NHS crisis) but after speaking to the other hospital’s consultant they decided to discharge me and hope it disperses without intervention. If I hadn’t initially been told I would be transferred and then had it cancelled, I think I might have not been so worried! Then different opinions about restarting apixaban ! Thankfully have good GP surgery and no problem getting appointments. Will keep taking the painkillers (can only tolerate paracetamol) and hope I can get rid of horrible cough that doesn’t help with the pain,. Hopefully when I do get a scan the haematoma will have started dispersing. Thanks again for your information.

[Ppiman in reply to Sentipede]

We’re lucky to have a good GP practice, too, and are so grateful to them. Fear and worry are such devils as they edge their way in so slowly and then, before you know it, feel so overwhelming.

We both have bad catarrh type coughs at present (in fact, since covid at Christmas we’ve not shifted the catarrh so it’s seemed like one long cold) and it’s caused me some concerns with pains in my abdomen - more a fear of hernias though as a scan showed them lurking!

I think you’ve had every right to feel worried but it does look as if you’ll soon be back to normal. Even the weather is looking up this week, so I hope you can find time for a nice walk through some lovely countryside and breathe the fine air! That will help bring the anxiety down even more.

Steve

[Sentipede in reply to Ppiman]

thanks again. Yes there are so many respiratory illnesses going around at the moment that seem to last for weeks. Fortunately covid tests have been negative, but this cough has been far worse than when I did have covid. Hope yours starts improving soon .

[Auriculaire in reply to Ppiman]

N acetyl cysteine is good for catarral coughs. It was recommended by our local pharmacy last time I had a cough and worked very well. It makes the phlegm more fluid. If your chemist does not have it you could probably get it at Holland and Barret as it is used as a supplement as well.

[Ppiman in reply to Auriculaire]

Thanks for that advice. We’re just off now to the pharmacy to pick up a prescription so I’ll get some. If it works, it will be a godsend as this has been a part of my life on and off for a long time.

Steve