I have paroxysmal AFl/AF, and I take 5 mg of apixaban twice daily along with diltiazem. I underwent total knee replacement surgery 2 1/2 weeks ago due to severe osteoarthritis of my knee. A few days before surgery, I temporarily stopped apixaban but resumed it 24 hours after the procedure. Since then, I’ve had no issues with AFl despite the intense recovery process.
A few days ago, my orthopedic surgeon removed the staples from my incision. He noted excessive swelling and ordered an ultrasound for a potential blood clot in the leg and as a precaution. He reassured me that, given my therapeutic dose of apixaban for AFl, a blood clot was unlikely. He emphasized that my current anticoagulant regimen significantly reduces the risk of venous thromboembolism and is more effective than the typical 2.5 mg apixaban dose or aspirin for non-AFl/AF patients.
The ultrasound confirmed no blood clot or deep vein thrombosis (DVT). While blood clots can still occur after surgery, the 5 mg twice daily dose of apixaban greatly reduces the risk. Another reason for anticoagulation.
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FraserB
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Not really relevant I suppose but in January 2010 I was diagnosed with paroxysmal AF. I was put on Warfarin and Bisoprolol ( in addition to blood pressure and statins meds I was already on ). In Nov 2015 I had right knee replacement surgery and had to stop Warfarin 6 days before going under the knife. When I was returned to my room, late afternoon, after surgery I was given two injections of Fragmin ( a bridging anticoagulant ) and in the evening 8pm/9pm ish I resumed my Warfarin. By which time I was already up and hobbling around with the aid of crutches. No issues at all, apart from mastering pain control and coping with my post surgery exercises.
I must say though at the 3 week mark when my dressings were removed I went to my Sports Injury Massage Therapist and for the next few weeks she gave me intensive massage right along the incision line and either side of it. She taught me what to do and I carried on the massage for following weeks. I never experienced any swelling at all.
Thank you for sharing this info as I'm due soon to have my left leg below the knee straightened and a total knee replacement on that leg and 3 months later a TKR on the right. My orthopaedic surgeon advised I would come off my 5mg of Apixaban 3 days prior and would have warfarin abdominal injections for a few days plus this is due to the fact that I had a stroke and TIA's at the same time as my paroxysmal AF was picked up in March this year. What analgesics were you given post operatively as due to my other meds I'm only allowed paracetamol 500mg x 8 in 24 hours. Ironically today, I was going to post about this and ask how others felt about initially coming off Apixaban...it scares me tbh as I know it's helping to prevent another stroke. I'll possibly gain my answers through your post replies. So what's next for you? Lots of physio? Daily walks? Did you have a spinal block anaesthesia? I've been advised I cannot have a general due to my AF and now further stroke risks.
I have 2 hip replacements too and so I imagine it will be a similar recovery time although knees are generally harder to recover from than hips. My left hip however, was a long haul recovery as it wasn't straightforward...it was my 5th surgical procedure on that hip. I wasn't allowed to drive for 4+ months whereas the right it was only 4-6 weeks. I feel I could well be 2/3rds bionic by the time 2nd knee is done 😁. Good luck with your recovery and rehab.
Hi there! I completely understand your concerns, especially about stopping Apixaban before surgery when managing AF and stroke risks. Before my TKR, my orthopedic surgeon and anesthetist looking a my medical history had me stop Apixaban two days prior, and I was back on it 24 hours post-op with no issues, but I know your situation may differ with the warfarin injections. I had a spinal anesthesia with a nerve block instead of general anesthesia because for my medical history it kept my heart stable, and I requested minimal sedation—enough to stay relaxed but I wanted to breath on my own. For me I know my AFl may kick in if I could not control my breathing, again everyone is different. The nerve block lasted into the next day, which helped tremendously with pain control, and I was prescribed Celecoxib for just three days after coming home—it’s a strong anti-inflammatory, but my surgeon assured me it was safe for such a short course. I was also prescribed a strong opiod which I did not use only because pain wasn’t severe for me in the first two weeks (though for others it is), and I was able to sleep well with extra strength Paracetamol and before my exercises it is a must. But unfortunately my swelling was intense from toes to hip. I quickly learned to **elevate my leg properly**—higher than my heart when sitting—to help manage it, and my surgeon sent me for an ultrasound as a routine precaution. The most unusual thing was not being able to lift my leg up in the air because of course they manipulate the muscle/tendons to do the replacement. There is so much out there on being "gung ho" on physio the first weeks after surgery but repeating the same mobilization exercises every day and consistently even though not as intense was key to my beginning recovery, and one day suddenly I could lift my leg up in the air. It sounds like you’ve already shown so much resilience with your hip surgeries—knees they say are tougher, but you’ve got the experience and mindset to tackle this. By the time the second knee is done, you’ll absolutely have earned that “2/3rds bionic” title! Wishing you a smooth surgery, recovery, and all the best—one step at a time each day.
Ahh thank you so much for your positive words of encouragement! A virtual hand holding is how it feels and I already sense that I will feel more positively focused to face it head on. I'm glad to hear too that you managed everything so courageously. Everything you have proffered is coming from a place of 'I understand you'...I feel your empathy, and I truly am grateful.🙏 I have been prescribed Celebrex in the past over a 15 year period and in fact 3 days is my max amount of days I can tolerate. My history with NSAID's goes back to 1974. I was advised at my out patient appointment last month, that I will require 3+ months of antibiotics and I seriously dread that as they really do not agree with me at all! 🤮Today I heard from the hospital which is 5.5 hours drive away and I must attend their 1 hour fitness assessment on the 4th February 2025...my son has the short straw as he is driving and the 1st surgery will then be 2-3 weeks later. It gives me time to sort out things here like POA's etc and a bit of time to gain a bit better AF state and lose a bit of weight post Christmas. I have an old high school bestie from my youth spent living in the States a hundred years ago, (feels like it ha ha) visiting me in June so that should put me 3 months in to my rehab...and then I can reschedule the 2nd knee assessment/surgery for July. I am not expecting to be able to climb mountains by then but at least will be a bit further down that road to recovery and hopefullythis terrible pain will be diminished. My 1st THR was 28 years ago and I was considered young at the time to be having one...it was with this same surgeon. Hence, I'm prepared to travel to see him. I well remember my long never ending days of recovery and rehabilitation from the previous surgeries...how one day even the simplest of tasks feels insurmountable and then one day without consciously thinking you 'wave that leg in the air'! 😊. Patience and tenacity are surely tested and the recovery process, whilst seemingly daunting and endless will ultimately be empowering. Thank you once again for the hope and belief re-instilled. 😊
Thank you for this timely post, I had a total knee replacement yesterday and my foot and ankle are very swollen. I was advised to stop Warfarin 5 days before and then after my operation I had an injection in my tummy and my usual dose of Warfarin, same again for today and then just Warfarin. The bandages are very tight and paracetamol and codeine haven’t touched the pain. They gave me morphine in the night but I was sick within an hour, I’m hoping a doctor will write me up for something stronger today.. Good luck and all the best for anyone else who is having or had this operation.
I was alright with the morphine - it just didn't touch the pain. Fortunately I took into hospital with me my home supplies of CoCodomol 30/500 ( prescription grade) . In the end hospital supplied me with the CoCodomol and I was fine. I learned about the CoCodomol - my GP prescribed it as a pain control in the weeks/months leading up to surgery. It worked real good. You will certainly need some strong reliable pain relief when you start your exercises and moving around.
Best wishes for a nice solid, sound and successful recovery. Apart from that your post op bit sounds pretty much the same as me. I was always in control at hospital as I self test my INR with my own Coaguchek device and was able to demonstrate to the medical team where my INR was in the grand scheme of things.
Aww, bless you. I know the first 48 hours after my hip replacements, I felt dreadful. I found it's best to not let the pain get the upper hand make sure that you stay topped up. It's harder to get back from it, if it has sneaked in. Take care
I am afraid that I am now rather sceptical about anticoagulation medication. Diagnosed with afib spring 2021, apixaban prescribed, stroke in June. (Left leg still affected.) DOAC changed later to Edoxaban due to cost, still taken daily. Just spent a week in hospital with a limb threatening ischemia (blood clot from groin to foot) in right leg, luckily sorted by a drip and injections to abdomen. Now changing to Warfarin which is being a pain to get the INR right. No-one can tell me why I had the clot when had been on DOACs for 31/2 years. My afib has gone from paroxysmal to persistent but is very light compared to many people here.
I’m really sorry to hear about everything you’ve been through—it’s completely understandable to feel frustrated. Even though medications like apixaban and edoxaban work well for most people, they don’t completely rule out the chance of a clot, especially if someone’s AFib is progressing or if there are other factors to do with the heart or blood vessels that can make clots more likely. At this stage with my own AFl/AF my two doses of apixaban a day work best but this too could change up as I age. So much individually can affect how well the medication works, too. I hope the switch to warfarin works best for you and especially gives peace of mind.
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