Swapping from warfarin to Apixaban

[travelfanatic]

Hi everyone, I'm changing my anticoagulant from warfarin to apixaban and have just been advised by my doctor to start taking apixaban now whilst I'm still on warfarin and then stop taking warfarin after 3 days. I have asked if I need to have an INR below 2 to start taking apixaban but the doctor said no, just start taking the apixaban now.

I feel like I'm not getting the advice I need, the surgery have almost washed their hands of me and everything I read about swapping has said that I need to have an INR test first and as soon as it's below 2, then start taking the new drug.

Please can anyone tell me of their experience?

Apologies if this is a question which has been asked often and many thanks in advance.

[daisyd]

I would have a word with a pharmacist if I were you

[SpeedyH]

Hi there. You are correct in what you have read. The NICE guidance on swopping from warfarin to the newer drugs state that you should stop Warfarin and once your INR has dropped below 2, start taking Apixaban. However, remember that taking Warfarin is not an exact science and many things affect your INR and often throw it temporarily out of range between INR tests so you should not worry too much about not being anticoagulated enough during the change over. I don’t think it is a good idea to take both unless there is a specific medical reason for you individually to do so, as there is a risk that too much medication may cause a bleed. I recommend that you speak to the pharmacist about your worries and they will probably contact the doctor themselves. When I swopped over, my doctor told me to stop taking the Warfarin and to start taking just the Apixaban the following day. With Warfarin you have to build up the anticoagulant effect over many days and maintain it as you know. With Apixaban, you are pretty much immediately anticoagulated and the effect lasts for 12 to 24 hours. This means you can take tablets late or miss tablets if you have dental work or blood tests etc that might cause bleeding. It is much more convenient. I think you are definitely correct to question your doctor’s advice. Good Luck.

[travelfanatic in reply to SpeedyH]

Thank you, that's very useful

[Suebo2 Moderator in reply to SpeedyH]

You are right. If swapping from warfarin yo skucansn yih d’Houston NOT that both together.

Check your inr. As long as it’s around 2.0

You can swap over.

[Hidden]

The NICE guidance covering the switch from warfarin to apixapan can be found at cks.nice.org.uk/anticoagula...

[travelfanatic in reply to Hidden]

Thank you!

[micran]

I have taken Warfarin for a long time, and have self tested for INR. recently i have had a persistent headache, not able to get a GP appointment so went to A&E, was given a headscan, result a brain bleed, I was taken off Warfarin, Losartan and Digoxin, was told I had a previous bleed. Now five moths later feel ok, I wonder did I really need all those years of Warfarin? Losartan and Digoxin Could have saved a lot of money paid out for Coaguchek meter and strips at £69 a pop.

[Midnight_Voice]

I had to buy my own CoaguChek, but I get the strips on prescription along with my Warfarin.

I know I need the Warfarin, as I was given it for six months after my saddle PE and then it was stopped. Six months later, I took myself to A&E with another DVT.

I do not want a third....

But I wonder if, for you, there is a way of using the meter to monitor the warfarin-less INR, or if it will now sit at 1.0, whether you have another incipient DVT or not?

[Hidden]

I was changed from Warfarin to Riveroxiban whilst in hospital for cardiac problem. No problems with changeover but this drug caused bleeding so changed to Apixaban. No problems. Warfarin takes a few days to get out of your system so that’s why you have been told to start the new one 3 days before finishing with Warfarin. You don’t need INR tests any more.

[Raoudha]

Please if you take both of them together you don t risk hemorrhagie

Thanks for feedback

[Raoudha]

I shift from antivitKto apixiban 2.5 with 1.5 INR and it s ok