When prescribed a pixie bun I was warned that if I get head injury I needed to attend the emergency ward to check for a bleed on the brain. I’m totally blind and have regular head injuries througho ut the week how serious I had injury should I be attending the emergency ward for Any slight bump or a really hard knock as I don’t want to be attending the emergency Ward 3 or four times a week for no reason my wife has suggested a crash helmet or hardhat every day, but I’m sure she was just joking
Apixaban and head injury : When... - Atrial Fibrillati...
Apixaban and head injury
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Exfat
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Good question, not sure that anyone really would have an answer. I have had slight knocks, got a bruise and a bump and not gone to A&E.
I would say a hard knock which causes headache, a fall where you bang your head and where others who witnessed your accident suggested you go. Please ensure that both you and your wife are aware of all the symptoms of brain injury and at the first sign of any of them - 999 or straight to A&E. I think you need to make your own judgement.
NHS website have advice which says go to A&E for head injury if you are on ‘blood thinners’ but I’ve never found that advice helpful because as you say, if you have regular slight knocks you wouldn’t be out of the place! And it’s not a place you want to be in these days! I’ve posted the link below but not sure if your AI will pick this up, hope it will.
nhs.uk/conditions/head-inju...
Apixaban probably has the safest bleed risk profile so it’s unlikely to cause a bleed but will exacerbate an existing bleed.
Hope that helps.
PS - Breathing for anxiety - you mentioned in a previous post that you struggle with the uncertainties of AF and indeed so do most of us. Techniques for dealing with the anxiety are essential - otherwise AF will control you. You are in charge, never forget that. You can lessen the anxiety - which helps you cope with any AF episodes and uncertainty by learning breath control and taking LSD = Long, Slow and Deep breaths using your diaphragm. Breath in for count of 7 slowly, hold, breath out for count of 11. This is called 7/11 breathing. If you find that too much - try 5/9 or even lower. The important thing is to slow your breath, make the out breath longer than the in breath and ensure you are breathing fully.
Hope some of that was helpful.
Thanks for the reply, my wife’s panicking more about it than I am. I’d avoid a and E as much as possible if I can so I’ll visit if I ever serious bang on the head. Thanks a lot
I consulted my cardiologist about this on my last visit.It has to to be a very hard knock on concrete.g where you have a bump as big as an egg and you have almost concussed yourself. Small knocks and small bumps and bruises are ok but as advised look out for any signs which could suggest a brain bleed i.e distorted vision, bad headache , loss of balance. I too would be in A&E for hours if I went every time I slipped and hit my head. Dont look on Google!!
I think it also depends on your age. Elderly people, due to physiological reasons, are more prone to brain bleeds.
I was told I could still snowboard as long as I wear a helmet.
It’s an interesting question. Before I reply, in order that we might be able to help others in a similar position, does your wife help you to read and produce posts or is there some audio package available that helps.
I agree with CD, unless you have very high blood pressure, most “ordinary” knocks shouldn’t be to much of a problem but if you break the skin or experience pain, dizziness or a huge bump develops you should be OK. It’s always better to be safe than sorry and because of your condition, A&E won’t be worried about seeing you but not the best place to be unless it’s necessary…..
Exfat in reply to
Thanks for responding as I mentioned to Sea dreamer my wife’s panicking more than I am about it. A&E isn’t the best place in the world I avoided like the plague or probably the plague would be the only reason I attend
Exfat in reply to
Referring to your question on how do I enter posts I have Apple devices which use a screen reader called VoiceOver. There are also other screen reading software for different devices. They aren’t always compatible with every website which means using them can be a little bit clumsy for me that’s why there are so so many spelling mistakes and dramatic errors in every post. I put on
in reply to Exfat
Thank you, that’s interesting. It’s so easy to take some things for granted, best wishes…..
in reply to Exfat
I’ve just watched one of the tutorials on YouTube, incredible, don’t worry about the mistakes!!
When I noticed that your title had spelled Apixaban correctly then read "a pixie ban" in the post I guessed you were using speech recognition but must say it really amused me. Small minds and all that. I will always think of as banning pixies in future.
Surely if you did have a head injury and rang 999 the paramedics would be able to assess whether it was serious enough to warrant a trip to hospital?
Hi yes it made me smile too!! Ive been on a pixie bun for the last year or so. Grateful for it keeping me safe and no side effects either. I cut my leg badly in the summer and was paniking that I was going to bleed to death waiting for an ambulance. Luckily the bleeding was no worse than before the drug and the medics fixed it all so its like new again!!
I use the dictate function on the phone. Sometimes it gets it right other times. It has a mind of its own. I think as I’ve mentioned earlier it’s a matter of being more careful and looking for abnormal symptoms
"I’m totally blind and have regular head injuries throughout the week "
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The blood thinner decision is one of risk versus reward.
Because of your increased risk of brain bleeds from multiple weekly head injuries, I personally would get a second opinion of whether my CHADS risk score warranted thinners.
If it did, you might be an excellent candidate for an LAA (left atrial appendage) closure device or procedure, which will reduce your stroke risk without thinners.
Your doctors advice is prudent re going to the A&E after a head injury. By all means, ask them for clarification, but do not ignore that advice.
Jim
Hi Exfat. I’m assuming your question is hypothetical for now, but if you have bumped your head and you are at all worried and in the UK, give 111 a call as I’m sure they’ll give you the right advice. The question is very reasonable, and I’d suggest you clarify with your GP for future reference so you hopefully won’t need that hard hat!
I wish it was hypothetical. I tend to have at least 3 to 4 head injuries a week, ranging from small bumps too much heavier knocks. It’s something I’m going to have to take into consideration how to proceed as I can’t be at A&E every time it happens to the response and consideration,
I think 111 would always advise getting it looked at. I bumped my head back in 2018, not long after being diagnosed with AF and put onto Apixaban. It was quite a severe bump and made quite a loud noise (!) although no bleeding. I was somewhat anxious so rang 111. I wasn't keen to go to A&E as I was due to go to Hampton Court Flower Show that day with my daughter but they said they were obliged to follow NHS guidelines and I would need to get it checked out. As a result I spent most of the day in Kingston A&E where I had a CT scan and was kept under observation for a period. No bleed but we missed the flower show - however RHS very kindly gave us free tickets for the following year 🙂
Better safe than sorry and good that RHS were kind. I guess that’ll be no good to Exfat several times a week though, so maybe not 111 then.
111 will send you straight to A&E they are afraid they will be sued. I find 111 . If you are worried ring 999
Exfat Discuss with your doctor your concerns. He can clarify symptoms of when you should visit A&E and perhaps to call to his nurse to discuss any incidents.
Also, he may reduce your dosage of Apaxiban if warranted.
Reduced dose Apixaban might seem to be an obvious suggestion re risks of brain bleeds, and was something I investigated for personal reasons. Unfortunately I found this 2021-22 Canadian research article ...
"Effectiveness and safety of low-dose versus standard-dose rivaroxaban and apixaban in patients with atrial fibrillation"
... and the Conclusions included the following ...
"... low-dose apixaban was associated with a greater risk of stroke/SE and death without a reduction in the bleeding rates."
So rather disappointing results for half-dose hopes. 🤔
It’s all a matter of being aware of the risks and acting on them. It’s something I need to take into consideration probably being a bit more careful would be the answer for me
I read the Canadian article with interest. I am for reducing my Apixaban dose and I try to free myself of prejudice. That said I thought the article was inconclusive and it did have a lot of caveats in the conclusion.
What nobody seems to mention is the irritation of nose bleeds, that was what drove me to reduce my Apixaban dose from 5.0 B.I.D. to 3.75 ish, by cutting the pills! That stopped my nosebleeds!! Incidentally, research says 40% of men don't know how to treat a nose bleed, yet this never gets mentioned when people are prescribed Anti-coagulants.
Yes, experiences like yours only add to my concerns about the "major bleeds" that the article results referred to(?), and is my main concern. I can see why your "nose bleeds" are of concern and very irritating. Glad to hear your dose reduction has worked for you, and is probably equally effective for strokes as a full dose. And thanks for reading the article and adding to the discussion with the caveats you expressed. I will return and read it again. The article results did seem to dash my hopes that a "half dose" would reduce "major bleeds" like intracranial bleeding. My specific concern is to avoid a repeat of the unexplained chronic bilateral subdural haematomas I suffered in 2017, which is why I haven't yet started to take the apixaban recommended for me via junior staff(!), but which does nothing to reduce my stroke risks.🤔
Bob
Interesting. You made me research again. (PubMed). I found this article and am still digesting it!
ncbi.nlm.nih.gov/pmc/articl...
You are a better man than me with your attempt to "digest" this article. It's a real struggle on my 5.9" phone, the only device I have, and the size of my brain doesn't help either.
Superficially, while it does contain interesting details I haven't read before (thanks for that), it reads like an advertisement for apixaban (eliquis). This view was somewhat confirmed when I looked at the authors and the list of "conflicts of interest", I saw the prominence of the USA eliquis patent holders Bristol-Myers Squibb Co. and business partner Pfizer Inc.. 🤔
In the end I couldn't see any particular endorsement of a half-dose approach being suitable for patients like me. Am I missing something?
Bob
I haven’t studied your exact situation, but here is my take: -
1) Drug manufacturers’ trials are on healthy young (under 65!) people, often males weighing 75kg ish. They are going to err on the side of an extra 10% for the therapeutic range of their drug.
2) No junior doctor is going to consider a lower ‘off label’ dose.
3) What I do is extrapolate my ideal dose, given my weight, age, and the effect of bisoprolol, perindopril, and amiodarone on Apixaban. (Source DrugBank). Even if I got a serum apixaban blood test, it wouldn’t show if that level was right for me.
4) What I like is an outcome test (in the case of bisoprolol its heart rate). In the case of Apixaban there is only guess work. That said nose bleeds, bruising and my reaction to insect bites are clues I am fully (over) anti-coagulated.
5) So, I take the calculated risk to cut(literally!) down to 3.75 mg. All doctors are against this move, EXCEPT the senior consultant who muttered:- “fair enough to deal with nose bleeds”.
Yes, good decision! but how do you cut a 5mg tablet? And thanks for setting out your protocol for deciding to reduce your dose. Very sensible indeed.
As for my concern re "major" and potentially catastrophic bleeds, I am still left with that Canadian article which suggested a full dose is better than a half dose. I will need to re-read it in the light of the concerns you expressed
But if you ever come across any research that specifically addresses Apixaban doses and "major" bleeding risks, please PM me with the details. Thanks.
Bob
I finally managed to copy a link to the article I mentioned ...
As James said, I'd say you must be a candidate for the procedure that changes the structure of your left atrium so that a blood clot doesn't form. This is called a LAA (left atrial appendage) closure. It's probably a post code lottery on how available this is. Here in the East Midlands they've been making a song and dance about it at the Leicester and Nottingham teaching hospitals.
Please do the research and then try and educate your GP, not always an easy thing to do.
Best of luck,
Mark
It’s always a struggle with the GP saying no to medication
But surely your brain is still going to bleed if you knock your head seriously enough, or for other medical reasons, regardless of whether your left atrial appendage is clipped or not?
I think that the reasoning is that with the LAA occluded there is an opportunity to stop taking anti coagulants and therefore reduce the possibility of bleeds being so serious. Agreed it wouldn’t stop them happening. It would help the OP avoid trips to A&E purely for precautionary measures and save him a constant battle with his GP maybe.
Could you tell us more about this ‘song and dance’ at the Leicester and Nottingham teaching hospitals. I know the Glenfield has a great reputation for its cardiac department and has been at the forefront of a few trials.
Assuming you don’t actually mean we get our ballroom shoes out.🤓
I think that in your position I would wear a crash helmet. Not a huge one but something and now in the winter months particularly it would not look that strange and would give you some degree of protection plus would have the added benefit of keeping you nice and warm and give you some sort of peace of mind. Why not? Around the house no-one except your wife would know. Outside headgear in cold weather is sensible.
I had a friend with cancer and she became completely bald. She refused to wear a wig saying that they were uncomfortable and friends would love her as she was and strangers don’t matter. Sensible attitude.
Yes better to be safe than sorry. I was never given apixaban originally due to the chad score risk, as I was deemed too young. But stroke unfortunately doesn't care if you are young or old, so if you are worried about brain bleeds sue to head injury perhaps have that chat with your GP or failing that your cardiologist. Care take of yourself. Thinking of you
thanks for the reply. I’m still arguing with my GP about what my chat score is I consider it’s lower than they do, but it’s a matter of something on how risky having a stroke actually is is the effort when
While walking with me, an elderly friend who is on warfarin tripped and fell badly, hitting his head on the pavement and causing it to bleed profusely (imagine my shock!). Some months later, he tripped while alone on his patio at home, again bumping his forehead badly. On both occasions, needless to say, he was taken into hospital but on neither was there any internal haemorrhage except, once, for a prolonged nose bleed, which was cauterised.
So, it seems that his warfarin had not brought about any internal bleeding. Whether that is a meaningful anecdote, I don't know, but the risk of bleeding is said to be real for people who take anti-coagulants. It seems, people differ in this respect, however, as some bruise easily whereas in my case, I haven't noticed any difference at all since starting apixaban.
If I fell and hit my head badly, though, I would go the A&E, and I think it's likely you should, too. I would be guided by my GP, if I were you.
Steve
head injuries bleed more than almost anywhere else on the body and can be very frightening. If it’s the first one you witness I’m fairly used to it by now they were lucky there was nothing internal. Thanks for the response and all the best
Yes, not only profusely but so visibly. I was covered in it even though it was quite a small cut that needed a single stitch.
All the best to you, too. I had a friend once called Tom who was totally blind and, well, he got through life better than I did at times - or so it seemed. His strength of mind and resilience would beat mine any day. He was a bit of a hero for me.
Steve
I love your humour! However, unless you have a very thin skull or you get very hard bangs on the head, I don't think the danger is likely to be as great as suggested. I remember when I first started taking the Pixie Buns, I got out of bed one night and walked straight into the protruding Velux window by the bed. I was very giddy and convinced I was about to die from a brain bleed, but it was just the shock. Since then I have almost cut my finger off with a circular saw (accident, not deliberate!) but it didn't bleed as much as I feared and soon started to clot (though it required surgery later!) and more recently I fell from a step ladder doing work on a shed, and really was convinced my end was nigh, I was so shaken up and bashed my head on something on the way down. I had a painful back and shoulder for weeks afterwards but no bleeds internally.
I think the advice is given to be absolutely sure we don't just ignore any potential symptoms after a blow, and caution is always a good thing. But our generation is made from tough materials and I don't think we need to worry unduly.
Thanks, I think I’ll just be a bit more careful and watch out for any unusual symptoms from any head injuries before going to a and E. Thanks for the reply
Just a thought; a rugby head guard might be an option when you're moving around at home. Very easy to slip on and off; folds flat to go in a coat pocket to take out with you if necessary and much less cumbersome than a cycling helmet or similar.
I only started on Edoxoban (similar to Apixaban) a few months ago and wasn’t advised about any risk with head injuries. Then I had a fall where I hit my head off the ground. I had to go to A&E because I had a bad cut on a finger and fractures in 2 other fingers. It was the triage nurse who told me that I would need a CT scan due to Edoxoban - luckily all clear. I think you should definitely discuss the issue with your gp for clarification. Re your amazing devices and mistakes, I have to say I absolutely love “a pixie bun “. It made me laugh. ( no offence whatsoever intended).
O too take apixaban and have fallen a number of times unfortunately, but the only time I had to go to A&E by ambulance was when I fell snd really crashed my head on the paving. I did have a brain haemorrhage and the hospital gave me the reversal drug, kept me in for a couple of days, restarted the apixaban after two weeks snd all was fine.
I wouldn't worry too much if you just bumped your head, it would only be if it was a really nasty bang, but if you felt really worried then please don’t take a chance, be safe
All the best
Pat x
My father-in-law died of a head injury causing a bleed. It was explained to me at the time, that the longer you live, the more the brain shrinks, giving it room to move around in the skull. Since it is connected to the lining of the skull with numerous small blood vessels, these get stretched. If you also have age related hardening of the blood vessel walls, they become more susceptible to damage when you bang your head.
I'm sure that you can judge for yourself whether a bang to your head is likely to be a strong enough impact to cause such an injury, and that is the time to call the ambulance immediately rather than waiting for any symptoms to develop. I'm not sure a crash helmet would help in such a case.
hi exfat
Might be worth considering wearing a medical bracelet to alert any paramedics or bystanders know that you’re on Apixaban. I wear one when I’m out and about in case of an accident or fall. Paramedics will certainly know what to do if they need to attend someone on Apixaban, perhaps in a RTA
HI.
Some years ago I regularly visited Portland Training College Notts. ( retraining place for people with physical problems.). I often saw people in there who were wearing special head protection gear so I know it’s available. Good luck.
If you were prescribed the right dose of Flecainide it might prevent episides of AF so that you wouldn’t need the anticoagulants at all. I stopped taking them a while back after Flecainide had ended my episodes. I’ve only had one breakthrough which was ended in a few hours with an extra pill so wouldn’t have been at any risk of stroke. Of course, we are all different but I do hope you find an acceptable solution.
Hi
I crashed into the Hardie Glaze wall before sinking rapidly to the floor with elbow in the tall plastic dog's biscuit container.
I had St John to check me. Luckily there was no wood stud behind where I hit.
My right got a manipulation and went totally black. Had R. Arm done 30 October after waiting 3 years. That accident stopped pain during night. Full tear, small others, reconstruct stableness for rotor cuff and burred a spur bone 1/2-1"!
I sat on a frozen bag of peas for coccyx.
They didn't seem to worry about PRADAXA 110 x twice daily.
I slept well that night.
It was at the back of head and no lump present. Just coccyx and arm sore.
You weren't need a helmet but talk to chemist and doctor. Some rugby players do wear protection.
Good one wife but she made it into a joke with a heavy helmet, I think.
cheri JOY. 74. (NZ)
I asked my cardiologist this question as well, because I can be bit of a klutz. My doctor said it had to be a pretty good hit, not something like hitting your head on the kitchen cabinet door or banging your head getting into the car, which is good because I've already done that today.
it would be great if there were a wearable device that alerts to the proximity of low door lintels etc. A bit like the kind of thing that beeps when reversing a car, warning of neighbouring cars/wall and kerb.
There are, but most accidents happen when you’re not concentrating on those devices only work if you’re concentrating really hard so they fairly impractical. They useful when you first become blind, but they just come with some and annoying and the batteries run out et cetera
I can imagine! I know some tall people with no visual impairment who constantly knock their heads too. I’m assuming you won’t need to worry with a minor knock, just the type that could give you concussion.
I have a friend, not on Apixaban, who was knocked ove4r in the street by a dog, hit her head and was unconscious for about 3 minutes. A neighbour called an ambulance but they didn't even take her to hospital. I felt sure that being unconscious would be a red flag but it wasn't. She was just told to watch out for worrying signs like falling asleep or a worsening headache.
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