I did a post a few weeks ago ,regarding commencing anticoagulants on a regular basis,previously had a PIP arrangement.Well my GP got clearance from a Cardiologist at the local hospital ,so I was good to go.I already had a supply of Apixaban ,previously prescribed by another GP,so I didn't need another prescription until this week.I used the Amina system to message the GP,but I got another GP who advised me to stop taking the Apixaban as all 3 previous doctors had not arranged a blood test to check how my blood clots before the anticoagulants were prescribed.Ironically I asked the last GP that specific question but he said this was not necessary.The problem I have now is my PAF has literally feel off the cliff edge with episodes of 12 hrs or more daily,but the GP needs me to be off Apixaban 72 hrs before having the blood test.I am not comfortable being in potentially in AF for the best part of 3 days without any anticoagulant,with the risk of clots.I feel I am now in between a rock and a hard place.Any advice would be great
Advice: I did a post a few weeks ago... - Atrial Fibrillati...
Advice
I have never heard of blood tests being necessary for commencing apixaban or other noacs.I wonder if this gp is confusing it with Warfarin?
I'd contact your cardiologist or his/ her secretary right away and ask them to instruct your gp with their recommendation to start Apixaban.
Good luck,and you are right to be concerned.
Thanks.It is very frustrating when GP,s give different advice for the same issue.I haven't seen by Cardiologist since 2018,and he is now retired.I am awaiting an appt with a new Cardiologist ,hopefully in Oct 2024,re ablation.
If funds allow,book an appointment with an Electrophysiologist, private. Costs around 200 pound see within weeks. They are even better than Cardiologists. But I'd still contact your new Cardiologists secretary and tell them the problem right away.
It's a fair way off until October!
I am not certain of the name of my new NHS Cardiologists .I will contact the appointments dept tomorrow to find out.I feel ok in AF and it doesn't stop me doing anything ,however long term it can cause damage to the heart,so I am looking at getting it back to NSR on a regular basis.Money is not an issue so I will look into the private route as well.I am some what surprised however,how quickly it has changed.
Go for it. This doesn't sit right. GPS are not experts and should never override those who are!Above their paygrade and expertise. Having had a few run ins,trust your instincts ( and mine!)
I feel sure your GP is confused. DOACs such as apixaban do not need testing . That dates back to warfarin (which I have been on for 20 years now.) Can you get a second opinion or maybe change your GP?
Hi again Bob,I understand you don't need a blood test for clotting,once you are on the anticoagulants,but should you have one before you start,as the GP is stating?
Why? You are prescribed an anticoagulant for stroke prevention. I have been involved with AFA since long before DOACS were available and never heard of pre presciption testing. With warfarin you used to be tested every day the first time you took it until reaching target INR and thereafter according to how well you stayed in range.
Ok thanks
highbury44
"I have been involved with AFA since long before DOACS were available and never heard of pre presciption (sic) testing."
I have found several examples advising blood and other tests should be undertaken prior to commencement of DOACs/NOACs - both in Australia and UK. I suspect in a lot of cases the requirements might have already have been covered off by recent test(s) done for other purposes e.g. routine periodic blood test. However, to the extent the requirements haven't already been covered off then it does appear tests should be undertaken prior to commencement of DOAC's
Examples include:
NSW Health (Australia)
"2.4 – Baseline laboratory tests
The following baseline laboratory tests should be performed prior to commencing DOAC treatment.
The patient should be further investigated if results are found to be abnormal:
• Full blood count (FBC)
• Prothrombin time (PT)
• Activated Partial Thromboplastin Time (aPTT)
• Liver function tests (LFT)
• Renal function:
o Estimated CrCl should be calculated using the Cockcroft-Gault Equation (do not use the
eGFR reported in pathology results) (see Box 2 for contraindications based on CrCl).
o A calculator, such as the Australian Medicines Handbook ideal body weight calculator
should be used for calculating estimated CrCl in patients who are overweight or obese
(BMI of 30 kg/m2 or more). For all other patients, use their actual body weight.
NHS Specialist Pharmacy Service (commisioned by NHS England)
DOACs (Direct Oral Anticoagulants) monitoring
Before starting
Required
Baseline
Baseline clotting screening
Body weight
Full blood count
Liver function tests
Serum creatinine (for creatinine clearance)
Urea and electrolytes
Monitoring renal function
Cockcroft and Gault is recommended for calculating creatinine clearance for DOACs. Estimated glomerular filtration rate can overestimate renal function and increase risk of bleeding events.
Yes I think you are right.It’s just a pity all GP’s don’t follow the same proceedure
Just the same as we're all different, so are doctors. Some might accept older test results whereas another might want more up to date results. Best to ask GP his/her reasoning.
If it was me I'd be consulting with my GP's office ASAP advising I was currently in AF and uncomfortable with stopping Apixaban because of the increased stroke risk. I'd request them to ask GP whether I should wait until after AF episode ends (if so, how long after AF stops before stopping Apixaban) or whether I should stop now and get the test(s) done ASAP after 3 days without Apixaban. Then what should I do after tests performed - wait for results or start Apixaban again if in AF at that time.
Thanks for your reply Bob.When I sent in the request through Amina ,it was directed to the previous GP,but unfortunately she picked it up.On the other occasions when Apixaban was prescribed ,they just checked kidney function,which on this occasion has already been done in May.Well I think I will continue taking the Apixaban and get an appointment with the previous GP as he specifically said I didn't need any blood clotting check.
I never had any bloods done before starting Apixaban, think your GP is confused as others have suggested.
I don't recall having blood tests prior to taking anticoags and if you are having long and frequent bouts of A/F then you need the protection anticoags will give you to avoid a stroke, I wasn't prescribed and I had a stroke as a consequence of A/F so, if it was me, I would be demanding (yes demanding) this necessary blood test!!!
Hi I recently started apixabam, confirmation from cardiology to gp that I need this med for persistent AF which I have suffered from for roughly 12 months since pace and ablate since then I have developed LVSD, HF and my pacemaker upper limit is set to 70bpm with no rate response as a heart rate above this makes my AF worse it then took over a month for the gp to get in touch with me to issue a prescription.I wasn't considered at first due to my age (53) as per CHAD scoring.
No blood tests required.
I am very new to anticoags having just started them in April this year. I am surprised at the apparent lack of standard procedure when starting them eg is weight relevant, are blood tests relevant re kidneys and clotting.
My cardiologist mentioned none of this when he said they were now necessary after 11 years of putting it off. So I started without any tests on Edoxaban 60mg (I am 12 stone) and only 2 months later did my GP surgery call to say a blood test re kidneys was best.
You need to start asking some tough questions of your GP or cardiologist whoever you trust.
That’s the NHS all over You always get doctors doing different proceedures for the same thing.I used to work for the NHS as physio for over 30years so I had a good insight as to how things work.When I first start work the NHS was commonly know as the No hope service.It says it all
I would try to suggest nicely that he double checks and pint out that he could be responsible for you having a stroke.Very difficult for you but you must be persistent.
How all goes well.
If you do an internet search you'll find that a full blood count and various liver tests are required prior to starting apixaban or DOAC drugs. I can't recall having one but mine were started in hospital, so I likely did.
I think this is a very wise move since the drugs can affect the chemistry of the blood and thus a baseline is helpful to discover any untoward effect.
You don't give your age or Chads2 score so your GP might have taken these into account, too.
As for an EP being somehow better than a cardiologist, well, this surprises me to read. They have both had identical medical training and will have had very similar patient experiences. An EP is no more than a cardiologist who has taken a short (well variable length in the UK) course on the use of catheter ablation techniques. They both work in the same team in a hospital, and both treat arrhythmias daily.
Steve
I am 65 in December,male,with a Chad score of 0.I understand that I would normally have to wait until the end of the year before I was prescribed the anticoagulants with a Chad score of 0 but we will be leaving the Uk for 6 months in October so I wanted to get things sorted before then.I think the full blood tests etc is correct,but this should have been mentioned a few months /years earlier by the previous GPS.So I will go back to previous doctor and discuss
I’ve never had a blood test before or since and I’ve been on apixaban for 8 years. I know you have to be tested with warfarin. I should get on yo your cardiologist or EP as soon as possible
But you really should be on an anticoagulant of some kind if your episodes of AF are that long. I was told that by an EP who knew a lot more about this than any GPS would.
I am on them but will need a new prescription by the beginning of August
Hi. So confusing for you. I’m not a medical professional, but I’ve never heard of a blood test before that type of anticoagulant, just for warfarin as far as I know that you test the blood. One thing we should all be aware of is that once we are on anticoagulants, if you go off, you are at risk for stroke, heart attack, or blood clot from the drug itself, not from our condition. I am amazed at how many doctors think it’s because of our condition that these things can happen. Even when someone is told to go off after an ablation, there should be a protocol that western doctors do not know about to naturally thin the blood first, so we lower our chance of having any of these thrombotic events from stopping the anticoagulant. That’s why there are two blackbox warnings one for stopping Eliquis and one in case you need a spinal while you’re on it. Hoping for NSR for us all💜💜💜
No blood test for me either and I was prescribed the anticoagulant by an arrythmologist doctor who was addressed to by my cardiologist
I was put on Apixaban without any blood tests by the Stroke unit consultant and have been on it over 8 years now. The consultant looked at what my heart was doing via an electronic device (about 6 electrodes and a monitor), not what my blood condition was.
All the best.
Roy
Honestly I have never heard of a PIP protocol for anticoagulation. Doesn't that defeat the whole point of being in an anticoagulated state if you wait to start it when the event happens ? Doesn't seem there is consistent stroke prevention if you wait til you recognize you are having AF possibly developing a clot.
I agree with the other replies here sounds like your GP has it confused with Warfarin/Coumadin protocols. Definitely pursue a second opinion, the GP is out of his league. Good Luck !
When I swapped from warfarin to apixaban about 5 years ago, the swap took place,with the proviso I had Blood tests inc liver and kidney function ASAP. These tests are repeated every year. I had to point out the annual check was what was recommended with apixaban and now I am automatically recalled annually. I suspect thisis age related as the literature suggests regular monitoring in over 75s
With Warfarin one has to have INR tests done regularly as a much more dangerous drug, but no tests for Apixaban, i think there must be more to your situation if they do this, are you in the UK. have you got issues with your kidney or leer that they need to check you on. as never heard of this ever
If you read up about apixaban you will see that regular kidney and liver function tests are advised especially important in the older population. Warfarin is NOT a much more dangerous drug, in fact it is tried and tested. It just requires monitoring as it is affected by so many variables. DOACs are in their infancy in comparison and we are still learning about them.
The leaflet enclosed does NOT state regular blood tests but it states that people with poor Bloods i.e. liver and kidney results should proceed with caution.
if people would only read thoroughly this is how wrong informatin enters the blogs.
My husband been on Apixaban for 8 years never needed bloods for this, but most of us do in fact get blood tests on occasion for Doctors records for other things, i.e. i have AF but went to GP recently due to episodes of dizziness she then did full bloods which came back excellent in all respects, but NEVER EVER have i know anyone have to have tests to go onto Apixaban. My Brother had AF too and sadly died at 60 with heart, he was on Warfarin, and had INR tests every week as it is very important that the INR remains within the imits,
Only if a person has suspected Liver or Kidney problems or irregulatities i have found in the UK on Apixaban we do not need bloods before or after.
I'm so sorry I didn't make myself clear. As a retired Clinical Nurse Specialist, I read more widely than the leaflet in the box and would never seek to mislead. The quote below is from the King's College Hospital leaflet for patients on Apixaban. It is available online.
"You will need to have a blood test before starting apixaban and at least once a year thereafter (if you remain on apixaban long-term)."
kch.nhs.uk › 2023/01
Apixaban (Eliquis) for stroke prevention in atrial fibrillation
I think we all appreciate this forum is for exchange of experiences and I'm sure we all know the person to ask about individual needs is the health care provider.
Yes but what sort of blood test?I have had the usual ones already in May but missing the one regarding clotting.I honestly believe it depends on who you see as to what they ask you to have in terms of blood tests
I'm assuming LFTs and renal function. Very unusual to be offered specific clotting one.
Never heard of anything like this, i am 77, never Bloods been suggested either before or after, but i do not have liver or kidney problems, maybe people with suspect organs need monitoring, it seems logical, as most of us never have to have any. All our Cardiologists cannot be wrong, sometimes best to leave the technical stuff or reading up on drugs to the people who totally know what they are reading.
Eliquis and Warfarin differ in their practical aspects and how they interact with the body to achieve their intended effects as anticoagulant medications.
Eliquis (Apixaban)
Eliquis’ mechanism of action centers around inhibiting a specific clotting factor called factor Xa. Factor Xa is essential for thrombin formation, a protein involved in the clotting cascade. By inhibiting factor Xa, Eliquis effectively prevents the conversion of prothrombin into thrombin, thus interrupting the clotting process at a crucial point.
The unique aspect of Eliquis lies in its specificity for factor Xa, which helps reduce the risk of clot formation while minimizing the risk of excessive bleeding. Eliquis is typically administered in fixed doses and doesn’t require regular blood monitoring, offering patients a more convenient anticoagulation option.
Warfarin
Warfarin, in contrast, is a vitamin K antagonist. It works by inhibiting the activity of vitamin K epoxide reductase, an enzyme necessary to activate certain clotting factors. Without active vitamin K, these clotting factors cannot function effectively and decrease the ability of the blood to clot.
One key difference between Warfarin vs. Eliquis is the need for regular monitoring. Warfarin’s effects can be influenced by diet, interactions with other medications, and individual responses, necessitating frequent blood tests to adjust the dosage and maintain the desired anticoagulant effect.
Both Eliquis and Warfarin offer valuable anticoagulation options with distinct mechanisms of action. Understanding these can help healthcare professionals and patients make informed decisions based on individual medical needs and preferences. Always consult a healthcare provider before starting or changing any medication regimen.
I actually wanted specific blood clotting testing since I was borderline on the scoring and have a familial history of hemorrhagic stroke. Neither my GP, cardiologist, nor EP suggested such testing.
the quote at the bottom is from a vets site. I realise animals other than ourselves may react differently. It would appear there are ways of measuring. If you search using Apixaban assay there are several articles and Leeds Hosp trust provide instructions for specialist testing. It also says Apixaban therapy does not usually require monitoring
"The apixaban assay measures drug levels based on its bioactivity as an inhibitor of Factor Xa (anti-Xa assay method). Measuring apixaban bioactivity will allow dose adjustment to prevent too much anticoagulant effect and risk for bleeding, or no anticoagulant action and inadequate therapy"
Hi
I have had a stroke caused by AF and Thyroid cancer being the overall culprit.
I have had 3 operations since my stroke in Sept 2019. On each separate occasion I have had to stop the anti-coagulant 24 x 3 days = 72 HRS!
I didn't have any problems and on day of op and 1-2 days after that.
One op was a particularly 'bloody' trumatised op where the lady surgeon expressed that she was nervous about bleeding. All went well and I was discharged the following day allowing 24 hours since the anaesthesia.
Some would stay in your blood stream.
And I can't remember ever having a blood test before being put on blood thinners but entry into hospital for stroke was a blur and they don'y always tell you before a blood test why you are having one.
But I understand you were already on full time anti-co.agulant.
I understand that only warfin needs to be blood tested.
cheri JOY 72 (NZ)
Sorry but never heard of having blood tests, i have PAF, and take two apixaban daily one morning and one evening, my Cardio told me its the best meds i could be taking as AF episodes with no anti coagulants can result in clots being sent up to the brain mainly.
I hae the PIP system of 2 bisoprol but it still takes around 2 and half hours for mine to go back to normal rate, each episode is making me feel worse now, but at the moment i get one a month or just under, hoping they dont increase, but i wouldnt dream of not taking Apixaban, it could save my life. You are at risk with AF and no anti coagulants, any cardiologist will tell you the same. my advice keep taking it.
Hopefully you can insist the GP fast tracks a referral to NHS cardiology - if not go private but you may still need a referral. It might take time depending how booked up the private consultants are in your area.
I hope you get answers very soon.
I’m with you on this and if you have them I’d be continuing to take them - I’m fairly sure you don’t need a blood test with Apixaban (Warfarin absolutely) - time to challenge the GP
Just to give you an update.I spoke to the GP ,who initially said I didn't need a blood test to check clotting,before starting Apixaban but has now changed his mind.I pointed out to him that the information guidance inside the Apixaban clearly states no blood clotting blood test is required prior to starting Apixaban.So he has past the buck on to my new Cardiologist for advice.The GP clearly does prescribe Apixaban with out blood clotting blood test but won't go against the other doctor.It is becoming like the old joke how many osteopaths it takes to change a light bulb.
afib again 6 times in 11 days
Spike in Pulse 
Apixaban double-edged sword?
