Apixaban clotting

[AvocadoSmasher]

Hi, I am 84, live in Australia and haven’t posted before. I have had Paroxysmal AF since beginning of 2019, five to thirteen episodes per year lasting on average 12hours long, and self-converting. Initially I was prescribed Sotalol with Dabigatran as my anticoagulant. Early this year I was taken off Dabigatran because it was causing stomach issues and now take Apixaban 2.5mg (my weight is under 49kg)

While taking Dabigatran, I had huge blood clots when I had nose-bleeds, but now with Apixaban nose-bleeds create virtually no clot at all – just a very tiny string.

This concerns me, as I wonder if I am at risk of a bleed instead of a clot!

I will raise this with my GP, but would appreciate your thoughts.

[Desanthony]

This is the correct dosage for someone of your age and weight. As you say this is a question to ask your GP and specialist cardiologist or electrophysiologist (EP). I have seen no difference in clotting time since being put on apixaban nearly 8 years ago - if there is a difference in clotting time for me it is minimal ad not noticeable. I am nearly 81 and take 5mg twice a day as my weight is above that where they would normally half the dose for over 80s.

Why do you have nosebleeds and do you have them often. Have you discussed the nosebleeds with your GP as if you have them frequently I think you should have the cause investigated and dealt with. Whilst on anticoagulants they often do not cause a bleed but cause an underlying problem to bleed and highlights a problem you didn't know you had which can therefore be investigated earlier which can then be treated sooner than it would have been.

Hope your Docs can sort this out for you.

[BenHall1]

Hiya,

From my own experience when first diagnosed it will be the Sotalol causing the nosebleeds .. NOT .. the anticoagulant.

Sotalol is a member of a family of drugs known as beta blockers, the other members are Bisoprolol and Nebivolol ( maybe amongst some others ). I have used all three BUT when first diagnosed my Consultant put me on Bisoprolol. Many years later I developed side effects and was then moved to Nebivolol and finally after my heart kicking off again in April 2024 I was moved to Sotalol ( which I am still on, and very successfully so ). This will be subject of a consultant review in late September 2024.

When I was put on Bisoprolol it was prescribed to be taken in the morning. The nosebleeds started a little later. These were random and full flow. I reported back to my locum GP at the time and she told me to take Bisoprolol at night - which I did and have continued to take Nebivolol and Sotalol at night. ( I was originally told to take 40mg of Sotalol in the morning and 40mg at night ). This caused me to be quite zombie- ish during the day and so I chose to act on my own and take all 80mg at night.

Result .......... still no nosebleeds. Maybe if you are taking Sotalol in the morning you should check with your GP about taking it at night. I really do not believe that an anticoagulant will cause a nose bleed ( no matter how logical it may seem ). I take Warfarin I might add. I have tried Edoxaban but found the side effects unacceptable.

John

[AvocadoSmasher in reply to BenHall1]

Thank you for your thoughts - I appreciate the input. It seems that it is a matter of trial and error to achieve the best result, so I'm glad that you have found what works for you. It took a while for me to get my sotalol dose right. It doesn't stop me having AF, but does stop the heart rate from going too high when in AF. I was taking 80mg morning and night which was causing me to feel lousy with low 40's heart rate, so I refused when the EP wanted to up the dose to 120mg to reduce AF episodes - I would have been flat on the floor! But later I started taking only 40mg in morning, and 80mg at night because all my AF episodes begin in the middle of the night. Taking only 40mg in morning raised my heart rate to a more normal level (50 - 60 BPM), which felt so much better and didn't increase the number of AF episodes. I told the EP and he was quite ok with that.

I explained in my reply to BenHall1 why I think that Nifedipine may be responsible for the nose-bleeds, and of course I could be wrong! But anyway, whatever is causing nosebleeds, my concern was only that blood was not clotting properly.

[Teresa156]

Hi AvocadoSmasher,

I would look into why you are getting nosebleeds, as this isn’t normal when on an anticoagulant and should be investigated. From your post, I get the impression you might think it’s something that you just have to put up with as normal, as it seems you’ve had many, but you really don't have to put up with this.

I’m on warfarin temporarily following an ablation, which is a different type of anticoagulant to yours. I’ve been on it over 6 months and have had no nosebleeds. I’m also on 1.25 mg bisoprolol ( taken AM).

[Cavalierrubie in reply to Teresa156]

I had nose bleeds before being diagnosed with AF so it was not related to medication. There was no cause for me, but l had my nose cauterised and the bleeding stopped. Whatever the cause is (they can just happen) you need to get checked and the bleeding stopped. If it is the drugs you need to have a review, but please don’t leave it as it’s not normal, or good for your wellbeing.

[Teresa156 in reply to Cavalierrubie]

Hi Cavalierrube,

I think you meant this for Avocadosmasher - she may see it, but you might be able to edit it?

[Cavalierrubie in reply to Teresa156]

Sorry. I think she should see it. When we do a post all the responses are notified to us. Thanks for pointing that out. Another senior moment. They are getting a bit too frequent now. 😫

[Teresa156 in reply to Cavalierrubie]

Hopefully she will - don’t worry, we all do it….I have done it before 😊 just thought I’d better mention it, just in case x

[Cavalierrubie in reply to Teresa156]

Thank you. Xxx

[jeanjeannie50]

I've had nosebleeds since being a child. A few years ago I had one that wouldn't stop, after about an hour and a half a friend called paramedics and they couldn't stop it, took me to hospital and when they couldn't stop it, tried cauterisation and that didn't work. By this time I was feeling quite faint through losing so much blood, I was filling one kidney dish after another. Eventually I had a huge bung put up my nose and inflated.

Tips for you:

I've now learnt to be more gentle when washing around my nose and never ever blow it hard and only gently blow when I have to. The result is I rarely get them now and if I do they are very mild. I also have a feeling that when we get stressed our blood pressure rises and makes the nose bleed even more. So beta blockers that also bring BP down have yet another use.

Jean