For those people who worry about stopping their anticoagulant for medical procedures in case they have a stroke maybe my experience might reassure them. All drugs have a half life so the amount of time you have to stop before a procedure is calculated taking this into account. For the "bans" it is usually 3 days. I have come off Apixaban 3 times now for two hip replacement ops and yesterday (Thurs) for a colonoscopy.The last two times for 3 days. After the first hip op they said they were going to give me a blood transfusion then changed their mind at the last minute. After the second op I got the transfusion. I wondered if I had bled more than usual on the table! Yesterday the colonoscopy went well and there was nothing wrong ( it was a surveillance colonoscopy as I had a colectomy in 2018) . I stayed overnight in the clinic just in case as my insurance pays for this and my gastroenterologist was happy with it. This morning the nurse came to remove my canula for going home . I told her that the last time I had a canula removed I was on Apixaban and the blood soaked through the dressing and started pouring down my hand and dripping on the floor. Well the same thing happened today . After she had gone I got out of bed to take my morning Apixaban ( restarting ) and noticed blood dripping all over the table . I had to go back round the bed to get to the nurse alert button and dripped blood all over the floor and the bed! They had to put a much thicker dressing and a bandage round it to give some compression. I had followed the instructions on stopping Apixaban to the letter. I had also stopped my fish oil and the other supplement I take which has a mild anti platelet effect. I can only assume that my blood does not return completely to it's level of pre Apixaban coagulation as quickly as they think for everybody . My kidney function is very good ( tested last week ) so it's not as if it's elimination is being compromised that way. This never happened to me before going on Apixaban. Next time I have to have a canula removed I will insist on a compression dressing . Good job my husband hadn't arrived to collect me. He would have fainted at the sight of all that blood.
Bleeding: For those people who worry... - Atrial Fibrillati...
Bleeding
All drugs have a half life so the amount of time you have to stop before a procedure is calculated taking this into account. For the "bans" it is usually 3 days.
I'm glad everything worked out in the end, but the half-life of Apixaban -- like all NOAC's -- is relatively short -- approximately 12 hours, not 3 days, meaning Afixiban should be completely out of your system in three days.
The half-life of fish oils on the other hand is about 2 days, meaning they can remain in your system for approximately 10 days , so that may be in part why you bled more than normal?
Hopefully, you've discussed your fish oil and other supplements with your doctor, because they're not always recommended when you're on anticoagulation due to the add on effect.
Jim
3 days refers to the amount of time to be off the drug pre procedure. I am well aware that the half life of Apixaban is 12 hours . That is why it is twice daily dosing. The use of the word "usually" should have alerted you that I was referring to the time off and not the half life.
I have been taking the same dose of fish oil for 25 years. I have been on Apixaban for 5 . I had no problems with bleeding when I had the colectomy in 2018 before starting Apixaban and I did not come off the fish oils then. My doctor said the dose of fish oil I take 1gm was ok. He would have no idea about the other supplements- French allopaths are abyssmally ignorant about alternative treatments and indeed there are moves afoot here to try and suppress anything other than allopathic treatments.
That’s sad as France used to be good for homeopathy, much better than UK. I had great homeopathic treatment in French Caribbean pharmacies for mosquito bites when all conventional topical treatments failed miserably, completely unavailable in UK.
When we came to live permanently here in 2001 the lady doctor I chose was a fully trained homeopath as well as allopath. Visiting her surgery was like stepping back into my 50s/early 60s childhood. She did not even have a computer! Sadly she died of an aneurism. Homeopathic treatments were reimbursed by the insurance . No longer. The war being waged on complementary medicine of any kind is getting worse and really took off during the pandemic . The Order of Doctors - a body brought in under the Vichy regime to control the medical profession -viciously persecuted doctors who strayed from the official narrative. Even people like Professor Didier Raoult in Marseilles who is a world renowned expert on infectious disease and is not per se an antivaxxer. Before the 2017 election Macron was often described as "Pharma's candidate" and proved that this was not a misnomer with his vaccine mandates. Recently a law has been passed which is to do with protecting people from cults but there is a clause which could be applied to alternative practicioners. It is very worrying.
Same attempts to suppress in North America I understand 'all for your own good' 🤔.
That's the big advantage of Warfarin and self testing at home ........... you can get your INR and from that you will KNOW exactly what state your blood is in from the INR number. 0 to 1.0 being normal. When I had knee replacement surgery I had to stop Warfarin (Coumadin) for 6 days prior. Went to hospital, checked in, got prepped and showed my Coaguchek device reading to the surgeon and anethestist which showed the INR value of 1.0 .............. and everybody was happy.
My GP refuses to prescribe Warfarin. Completely sold on the DOACs. But Warfarin was hardly used here before anyway. When I first went on an anticoagulant I was given Préviscan another vitK antagonist that had bad side effects too.
Yes, Warafin does have certain advantages that you mention and it would be nice if similar self testing was more readily available for NOACs, but I think the marketing pitch for NOACs (no testing required) well not make that a reality!
That said studies show less incidence of both mortality and intercranial bleeds with NOACs vs Warafin, especially those with prior events and over 80.
They also have more rapid onset and they can be reversed quicker, now that reversal agents are available.
For these reasons and more, I ended I ended up choosing a NOAC over Warafin, but I do understand your point regarding knowing exactly what your INR is at every point in time, which favors Warafin and can see why someone might choose it.
Jim
Jim, I'm a person who likes to take control of his own destiny. You certainly seem to be an AF hobbyist with your range of comments .......... me I'm an ordinary Joe who still ( at 79 ) drives double decker buses ( albeit part time ) ........ but all this stuff about mortality and intercranial bleeds ......... bit alarmist don't you think? What evidence do you have for this per capita of the population who consume this drug ? For this Joes money its rubbish ....... when properly prescribed/ supervised by a quality medical/healthcare professional anyway !
Now, before any smart ass on here says anything ......... like what the hell am I doing driving buses at my age ... I'd say why not if I want to and particularly when I am confidently able to pass an annual DVLA inspired Medical in order to LEGALLY retain my bus driving licence. From what I've seen on the road it might be wise for our licencing authorities to apply this same requirement to 60 to 65 year olds ...... you'd be surprised where I've seen cars driven, particularly in reverse .......... the so called experts, old men in particular !
I have my own Coaguchek device and get my Test Strips on NHS prescription,I do whatever I like, whenever I like, if I fly to Australia on holiday I take my kit with me and if I feel like it I self test when I'm away ........... its a non issue here and dirty pool marketing by the manufacturers of these NOAC's. Now its time to put it in perspective for the average reader on here ........... self testing for an INR is no more of a drama than a diabetic goes through whenever he/she does a finger prick test to get their readings. If I were a diabetic perish the thought of taking a pill and relying on it to control my blood sugar reading without know what exactly my blood was doing.
You are being very, very economic with the truth, perhaps even promoting in a marketing fashion, NOAC's with your comments. 😱😱
The drug manufacturers and their marketing arms are talking total rubbish and are totally alarmist in this type of product promotion.
John
Most of the superioity of DOACs over Warfarin comes from patients on Warfarin not using Coagucheck regularly and adjusting their Warfarin to keep their INR in the required range. Those who have to rely on monthly or six weekly blood draws at a doctor's surgery or anticoag clinic often have a time spent in range of well under 90/95%. For the clinical trials 65% in range was the average for the Warfarin arm. There have been post marketing trials that show that DOACs are not superior if the time in range on Warfarin is over 90%.
I am sure I'm part of the great age freak show - both mentally and physically, my heart (much less so) is damn well worn according to a medical professional. Nevertheless I've just looked over my records and my 'In Range' time for the last 3 years is 90% ....... so why am I gonna change.
I have tried Edoxaban ( my GP's choice ) as she claimed it was more 'compatible' with pain killers she had prescribed. The whole exercise was a bloody disaster, pain killers didn't work and Edoxaban gave me the most horrific nightmares, beyond horrific and the loss of sleep was beyond acceptable.
Ultimately we went head to head and I told her NO MORE NOAC'S end of, back to Warfarin. I still had some in date Warfarin tablets and of course my self testing technology and ultimately I put myself back on Warfarin and served her a written letter advising of my action. Ultimately she reinstated Warfarin and test strips on my repeat prescription orders list.
I might add that I've had to stop Warfarin for 3 or 4 medical procedures ( for different lengths of time depending on the procedure ) one of which was knee replacement surgery. Stopped Warfarin for 6 days to get my INR down to normal, on the slab/under the knife ... returned to room, then a double injection of Fragmin and back on Warfarin in the evening. No problem. The problem is people speaking with forked tongue who don't want facts like this publicised, my GP being one.
hi. Just following your thread as I'm 5 days post hip surgery. I stopped Apixaban for 5 doses prior to op. Then started half dose for 7 days to reduce bleeding risk. I've had needles and canulas galore over the 48 hours post op - none of them bled.
i was told I could not have have nsaids as I am on Apixaban.
my friend had her hip op a few days before me at a different hospital and has been prescribed Apixaban for 4 weeks and nsaids, so it's ita bit confusing. I can only have paracetamol - codeine was the other option but tbh I'd rather the pain than codeine side effects.
I was prescribed Paracetamol and Tramadol after my hip ops. I would rather put up with the pain than take either as they both cause me digestive problems and the Tramadol makes me itch when it wears off.
I've not had operations but had three tooth extractions, I stopped Edoxaban 3 days before, had no issues with bleeding. I also was in hospital last year with umpteen blood tests and cannulas, no issues with bleeding then either and I was taking my anti co ag.
I’m on apixaban, it doesn’t cause me many problems. But after going from apixaban to edoxaban and going back to apixaban I know it’s this that causes my itchy irritated dry eyes in the evenings.
At the end of May ‘22 I had a toe and an angiogram in two days one after the other. Had canulas in my hands. After the toe the nurse took the canula out and put a small pad on and said press down really hard on that till I tell you to stop. It was about ten minutes, it was absolutely fine barely a bruise.
The day after the toe I had the angiogram and the nurse took my canula out in a rush as I was going home, it wasn’t stopping bleeding and she put a massive pad on it which meant I couldn’t really put much pressure on and said it will be ok when you get home. I left it a while after I got home and when I took the pad off it had bled but under my skin! It took weeks to go and was so sore for a good fortnight.
You could barely even see the angiogram entry site which has massive pressure for an hour afterwards.
I did have to stop the apixaban for the angiogram but they gave me a dose of heparin afterwards which really does cause bleeding and bruising.
Over all the difference in the two different teams was like night and day though. The toe team were brilliant, the angiogram completely awful, it wouldn’t stop me having another but it was a miserable experience.
I’ve had canula since and always now hold them really hard for 10 - 15 mins and have had no problems. Normal blood tests, in a good vein in my elbow usually bruise badly because they are so rushed they can’t wait to get you out of the door. I’m not expecting 10 mins but anything would be better than nothing.
Thats a horrible bruise. I had a blood test last week taken from the crook of my left elbow. Afterwards a big purple lump came up which took a couple of days to go down but the bruising lasted a week. I've never had a lump come up after a simple blood test before. I have horrible veins and she did not hit it first time so maybe it was wriggling the needle around to find the vein that caused it. I hate blood tests and canulas!
I have mentioned before on this site about blood tests - my physio told me to press on the area for 10 minutes after a blood test. I always tell the phlebotomist I am on edoxoban and they usually press the site for a minute or so and then I go out and sit outside in the waiting area and press for 10 minutes as a result I now get very little bruising. After the first time when I did not do this my arm was black for ages.
With respect to canulas I was in hospital recently emergency admission (unrelated to AF) and canula put in my arm and I was told not to take AC so for two nights I had no AC (I take them at night) and on third day when they removed canula there was no excess bleeding.
Good idea to sit in the waiting room, my routine ones are usually in winter, I’ll not bother putting my coat on in the testing room and then I can put some pressure on. I try and push with my thumb as soon as the needle comes out and they knock my hand out of the way putting the dressing on.
Ooh, the wriggling a needle around had me cringing up for you just reading it😬, it sounds awful and getting a lump would be worrying. Did anyone look at it or did you just keep an eye on it yourself?
It’s not that noticeable in the picture but the blood had even seeped into the bottom of my fingers 😡
No I only saw the lump when I got home and took off the dressing. It was a horrible draw. Our local lab where we have our blood tests was taken over a couple of years ago by a big company when the guy who owned it retired. It has gone downhill a lot and even our GP complains about it. Before there was a lovely lady who worked there and was an ace with the needle - I always used to ask for her to do the draw. I think she must have retired too. Since then it's pot luck whether I get someone who hurts me or not.
You must dread going for them, I’ll take a bit of bruising over that. Awful that you have had to have so many procedures too with all the blood draws and canulas that go with them.
Two years ago I was blue lighted in with severe abdominal pains - turned out to be infected appendix. They would not operate until blood tests were clear of anticoagulant (Rivaroxaban) which took 4 days. I had so many canulas in for antibiotics, pain relief and fluids, it was getting hard to find veins plus so many blood tests. One of my problems is that they can only use my left arm, I have had breast cancer and lymp node removal in right arm so not allowed to have blood drawn, canulas or even blood pressure taken on right arm.
But the worse was on the morning that I eventually had the op a junior registra came to take a blood sample, she seemed very hesitant and not a lot of veins to choose from, she tried for a vein on the back of my hand. She put the needle in and it went straight through the vein. The back of my hand and going upto my wrist filled with blood, a staff nurse noticed and immediately put pressure on it, it looked alarming as if I had been in a bare knuckle fight. That afternoon they decided to operate and when the anestatist saw it he was horrifed but he did then laughed and said I will find a vein somehwere and he did. That took 3 weeks to clear.
Horrible! The private clinic I go to has a phlebotomy service who do all the blood draws for tests and they are pretty good but the canulas are done by the nurses. When I was there for acute diverticulitis before my colectomy my veins kept packing up for the iv antibiotics and they had to find a new one for the canula. In the end my gastro had to switch me to oral. I think the nurses complained it was upsetting them torturing me to find a decent vein. One poor guy was nearly in tears. I got a reputation for having useless veins so when I went in for the colectomy a few weeks later the ward nurse refused to do the canula and sent me to theatre without one saying "they can do it down there!" Same thing happened when I went for my twp hip ops. Luckily the nurses in the theatre bloc were better.
Hi
I've had 3 operations (not heart related) since the stroke,AF and thyroid pap cancer.
I am on PRADAXA 150mg x 2, then finding the transferred hospital had raised from 110mg x 2 daily to 150mg x 2.
Each one had required a GA.
Looking through reports on the actual procedure through the cannula I was given something added to the rest of ingredients in the thyroidectomy. I shall examine the other two later discharge papers.
So the operations were Feb 2020, March 2022 and late October 2023.
It shows that even the 3 day stop is monitored on the day of the operation and if cannula is still there this continues.
I showed blood clots after the gynaelogy operation.
The orthopaedic surgeon said restart the night of the operation but the anaesthetist said no restart evening of following day.
But I decided the day after so start on the night of the 2nd day after.
But it pointed to other things not right. The surgeon was prescribing DOAC pain but I said that my Dr had prescribed ready in advance tramadol, paracetamol plain and with /codeine.
I experienced very little uncomfort with the latter keyhole.
I was given OXY-NORM and paracetamol plain. In 3 days I was off all meds except 2 x 1 a day.
With oxy meds it is important that patients are informed until they understand the dependence and the overdose of these drugs. Oxy-normal three times a day whereas paracetamol twice a day.
I was informed that a young cousin in Canada 21 years died after an orthopaedic procedure whilst not following or forgetting to take meds strictly as prescribed. That is so sad.
cheri JOY. 75. (NZ)
My pharmacist told me that the Apixaban I take stays in your body a lot longer than people think.I'm awaiting heart surgery and have been told I'd have to stop at least 5 days prior to surgery.
I had horrendous toothache last year and spoke to my pharmacist about possibly stopping Apixaban for a couple of days so I could take Ibruprofen.
He said absolutely not, as I'd need to stop it for at least a week for there to be no interaction and if I asked, he wouldn't sell them to me. 😊
That's very interesting. For my first hip op the anaesthetist took me off Apixaban for 8 days and prescribed twice daily Lovenox jabs . I always thought she was being overcautious or even thinking it needed to be the same as Warfarin. My cardiologist said for the 2nd hip op 3 days was adequate and my gastro told me to stop on Monday night which gave slightly less than 3 days as the colonoscopy was Thurs afternoon. I also think I am a slow metaboliser of drugs as painkillers last ages for me.
Lovenox sounds like an entirely different drug 😁.
It'some sort of heparin. It leaves your belly black and blue like one giant bruise!
😳
I recently had a bad fall on 3/4th day of our Italian holiday leaving me with a huge haematoma on top thigh/buttock and a bruise bigger than the biggest dinner plate! That was 3 bit wks ago, still got bruising that has traveled downwards and still the painful haematoma! I’m in Apixaban, 5mg twice a day, I’m also a ‘bleeder’ of unidentified reasons! Husband is convinced this is down to the combination and over anticoagulated. So am I.
Anyone got any ideas how I get tested for the blood disorder? Oh and I have Haemochromatosis Compound variant
I think I may be over anticoagulated on the full dose of Apixaban . Most of the time I do not take the full dose as it makes my life a misery with increased pain and digestive issues. That's the trouble with the DOACs - or most of allopathic treatment - one size fits all and tough if it does not fit you. Hope your leg gets better soon.
Not what you're looking for?
You may also like...
Bleeding (sorry …rather descriptive )
Blood thinners and bleeding
Stroke v Bleed risk.
Upper Gastrointestinal Bleeding with Sotolol
Gums bleeding with Rivaroxaban
Bleeding stools
Nose bleeds
Bleeding Gum
Ablation causing internal artery bleed
