Bleeding Nuisance

[MacGrumphy]

Just back from hospital following the third major bleed from my bowel since I started taking Apixaban in December 2018. Following a colonoscopy the problem was diagnosed as a haemorrhoid at the top of my rectum. As soon as I stop taking Apixaban, the bleeding stops. I am then told to stop taking Apixaban for a certain healing period. In the first instance it was three days, second time ten days and this week four days. There doesn't seem to be a text book recommended time, which I find quite surprising. It all depends on the consultant in charge at the time.

[jeanjeannie50]

I think that I'd want to be changed to a different anticoagulant, actually I know I'd want it to be changed.

You can't go on like this having all the worry that the bleeding brings. Is it the only anticoagulant that you've ever tried?

Jean

[MacGrumphy in reply to jeanjeannie50]

I started off with low dose aspirin before being transferred to Warfarin followed by Apixaban in 2018. No bleeding problems with the first two. Last December following my second major bleed I had a colonoscopy and an internal haemorrhoid was found at the top of my rectum plus extensive diverticulitis. I was put on a waiting list to have the haemorrhoid banded. During my time in hospital last week I was examined by a lady consultant who couldn't find any haemorrhoids (she hadn't seen the colonoscopy report) and decided that the bleeding was probably caused by the diverticulitis, so I was sent home. My GP isn't too happy with the situation and will make enquiries. However, I feel perfectly well, so life goes on.

[baba]

You need to have the haemorrhoid  sorted.

[SeanJax]

here is the dilemma. You need to take apixaban and it makes you bleeding thru the internal hemorrhoids and probably external ones too. You need to get it removed and the surgery is risky at your age. Sorry for the age thing. Next thing post surgery it will be very painful, easy to understand. So probably they will give you some opioids painkillers. So imagine at your age take painkillers you might fall easily. So get a caregiver for a week or more to help you out. Last thing the pain would be more pronounced when you poo. Easy to understand. So prepare your mind and make your decision accordingly. The colonoscopy messed you up. In the States we stop doing colonoscopy after 70 or 75 years old because there is no benefit. Even with a polyp to become a tumor, it would take 10 years to kill the person. So no more colonoscopy from now on.

Another option is if the hemorrhoids are strictly internal there is a medical procedure which is called hemorrhoids ligation using a rubber band to cut the hemorrhoids of its blood flow and it dies by itself. it might be successful and avoid you to undergo surgery. If so see with GI surgeon or specialist.

Best wishes

[frazeej in reply to SeanJax]

Sorry you had such a bad time with your hemorrhoid surgery! In contrast, I had both internal and external "roids" done, and it was a piece of cake. I told the surgeon on followup that the most painful part of the whole deal was ripping tape from the bandage off my lower back, and that he should win a Nobel Prize for "roid" surgery. The only upset I had was that I had put the procedure off for 15 years, and then 15 minutes solved all the problems! It's all in the skill of the surgeon!

[Thomas45]

I'd try a different anticoagulant.

[waveylines]

Sounds like they need to deal with the haemaroid. I too have experienced problems with bleeding on an anticoagulant. Was fast tracked twice due to bleeding. Stopping the anticoagulant stops the bleeding but reoccur when resuming. One source was dealt with resolved that area but not others. In the end my GP & I settled on halving the dose and I've not had any big bleeds since. My EP says there is research going on at the moment looking into individual need of anticoagulation as prescribing is currently based on population needs. It's quite possible I needed a lower dose. However this research will take another four years. Therefore he could not guarantee that taking a half dose of Apixaban would give me the same level of prevention from stroke.So it's a balancing act. I think you need to discuss this further with your Cardiologist.

[Rainfern]

With ref to Seans comments above - age these days tends to be assessed (or should be!) according to various physical markers, not just years. My mother in law underwent successful surgery in her 90s and lived long enough to get a telegram from the Queen. I agree with Jean, start by changing to a different anticoagulant.

Hoping that you get this sorted, it sounds nerve-wracking!

[browng]

Have you considered stopping anti-coagulants all together?

I have a similar problem in that I had bouts of internal bleeding when on NOACs and I had a very long discussion with my EP consultant who is a senior and very experienced consultant at Royal Papworth.

We discussed the risks of a clot against the the risk of a major bleed. After 2 ablations my AFIB is short, typically less than 1 hour in duration, and I came to the conclusion, based on the evidence that my EP consultant provided, that my risks were higher on NOACs than the risk of a clot because of AFIB at this point. I have a good quality of life at 72 years old.

It was not an easy decision but we keep it under review and will reconsider re-starting NOACs if the AFIB extends its prevalence. My Apple Watch has only picked up a couple of attacks this year so far, and I use a Wellue chest monitor overnight on a regular basis just to make sure.

I should say I am on Flecainide 50mg x 2 which seems to have calmed the AFIB attacks in the last 12 months.

MacGrumpy, it really depends on your personal situation and the advice of your EP.

Might be worth discussing with your EP?

Gordon

[Ppiman]

I have similar and had a troublesome but benign polyp removed from an internal haemorrhoid last Wednesday. What trouble that caused for such a long time. I was told to restart apixaban on Monday this week having stopped it the previous Sunday, but as I still lose a little blood each morning, and somewhat less after most loo visits, my GP said to hold fire with resuming the anticoagulant till tomorrow. Luckily, I haven't had any AF during this time or I would be much more worried.

Over the nearly four years I have been on these drugs, I have found no difference between apixaban and rivaroxaban in terms of bleeding. In fact, they don't seem to increase my bleeding at all so I am hoping I can restart without issue.

Steve

[Tapanac]

first of all haemorrhoids do bleed so that would be your first concern. Better to get them done rather than have a stroke through stopping apixaban (there is a reversal drug for it as I have been given that when I had a really bad fall causing a brain haemorrhage).

Also 80 is not too old for surgery as my husband is 81 and awaiting a groin hernia. Anyway your surgeon will decide when you have your pre op assessment

Good luck

[JOY2THEWORLD49]

Hi

Latest research. It reads no anticoagulant if you have cancer! Risk bleeding.

Have you been properly diagnosed.

cheri JOY. 74. (NZ)

[Jancam1943]

look into getting the watchman. I did and no more bleeding. Best decision I ever made

[Camelotte in reply to Jancam1943]

what is the watchman please?

[mav7]

I am then told to stop taking Apixaban for a certain healing period

Insure your cardiologist/EP and gastroenterologist communicate on the issue and follow their advice.