Apixaban and Antidote for bleeds.

[Hullensian]

I am taking Apixaban 5mg x 2 per day. My doctor has warned me that there is no antidote for bleeding with this medication. I, naively, thought he meant bleeding from a cut, but no, he said, he meant if I had a brain or stomach bleed. I am very concerned about this, ie what happens if I have one, or what happens if I have to have an emergency operation, apart from the info that if an operation is planned I would cease the Apixaban prior to the op. I have trawled the internet, asked the doctor, asked the BHF and no-one will give me an answer. I am left assuming that they will not respond because the answer is that one "dies". So, have anyone who is taking Apixaban had either a brain, stomach bleed, or an emergency operation? Sorry if this worries people who are taking the drug who had no knowledge of this.

[skid112 Heart Star]

Hi Hullensian, I should probably avoid trawling the internet for drug side effects if I were you and concentrate on your GP, he is the one who told you about them. By all means call the BHF for advice, but it will be generic and will probably refer you back to your GP. I have seen the leaflet from the drug (via the net) and yes it doesn't read well, but then most drugs have side effects, some significant some not

From the leaflet, the first lines "Do not take Eliquis if:

you are allergic to apixaban or any of the other ingredients of this medicine (listed in section 6)

you are bleeding excessively

you have a disease in an organ of the body that increases the risk of serious bleeding (such as an active or a recent ulcer of your stomach or bowel, recent bleeding in your brain)"

I would assume you do not have any of these conditions? It doesn't seem to cause them so I would be asking your GP why the hell are you trying to scare the living daylights out of me

[Hidden]

Hi there - you're right in saying there isn't a 'direct' reversal/antidote to this drug at the moment, but this is actually the case for most drugs that prevent blood clots. We have many ways of helping to stop major bleeding in case of emergencies, usually with drugs in the first instance. We then confirm where the source of the bleeding is and take action - this may sometimes require surgery, but it depends on the source. Surgery may also be necessary even if someone is on warfarin and receives vitamin K to reverse the effects.

There are research trials ongoing to try and formulate a reversal/antidote for apixaban so perhaps there will be one on the market within the next 5 years or so. In the meantime, if you're worried about your risk of major bleeding then you can speak to your GP or specialist. It's worth mentioning that these drugs are very safe and the risk of major bleeds is very low - in some cases lower than with warfarin too.

I hope this helps,

Chris

[Prada47 in reply to Hidden]

Hi

I always try to work on the basis that the medication will do me more Good than Harm and more importantly that the Dr will have evaluated the Risk and Reward. The other bit I find reassuring is that NICE will not have licensed a Drug without Checking the Drug companies trials, and they to will have evaluated the Risk and Reward !!

( I Hope )

Regards

Frank W

[Hullensian in reply to Hidden]

Sorry, whilst I appreciate your taking the time to respond to my worries, your reply hasn't helped because it isn't a response from someone who has had the experience of a bleed or an emergency operation and the fact that there are research trials ongoing to try and formulate a reversal/antidote and perhaps there will be one within the next 5 years or so, is quite a worry. Regards.

[Hullensian]

Thank you for your response.

[Prada47]

Hi Hullensian

I have had a Bleed ( Brain ) caused by an AVM rupture.

My Cardiologist and Surgeon would not carry out the bypass op without the Neuro Surgeon saying it was safe to do so, and that the ( medication anti clotting ) used during the by pass operation would not cause any problem.

Hence I had a Brain MRI prior to my operation and the Neuro Surgeon wrote to the Cardiac Surgeon to say in her opinion I was at a slight increased risk BUT it would be safe to carry on.

Continuing the Risk v Reward

I need a PCI to unblock an occluded Right Coronary Artery.

The Cardiologist has told me there is a 70/75% chance of success at the 1st attempt, but there is an increased Risk from Complications I believe this is because he will need to go against the flow of blood for part of the procedure. So I have it in writing from the Cardiologist that the increased Risk moves from 1% to 2 % so I was asked would I like to proceed with what is going to be a difficult procedure. 1 to 2 hours in a Cath Lab is I believe quite a longish procedure, and to continue the Risk v Rewards the Cardiologist will use coated stents so as to reduce any Risk of a clot causing any problems with my past Brain Haemorrhage.

With a Risk of 2 in 100 I have elected to go ahead, because it will relieve some of my Breathless Symptoms caused by Angina and Heart Failure, added bonus, will/maybe/should allow me to be able to get rid of the Carmil XL ( isosorbide mononitrate medication which causes me to have headaches.

Long winded reply I know, but I do have some experience of evaluating my own Risk v Reward scenarios , after listening to the advice of Experts that's why I felt able to comment .

Regards

Frank W aka Prada

[Hullensian]

Thank you so much for your comprehensive reply; I really appreciate your taking the time to respond. Should I need an op for any bleed, if Specialists communicated with each other and then explained to me the pros and cons, as your's have done, I would be confident to make a decision. Best wishes and I look forward to your updating me once you have had your op and completed your convalescence. Obviously, I do not know the date of your op and do not expect you to divulge such personal information. (And don't want you to think I am prying)

Regards

[Prada47]

No problem, I am in the process of moving from Aberdeen to Ferndown ( Dorset ) so I have cancelled off the waiting list for the PCI in Aberdeen,

Just had a phone call from our buyer who has confirmed her buyer has had his mortgage granted Phew. This stress is no good, still looks like it is sorted.

Just to fill in a bit I had a MI in 1982 aged 34 and the cardiologist said these things happen " just go and live your life to the full " which I have done worked around the world in some really remote locations with out worrying about my heart !!. In 1982 stents hadn't really been an option still to cut a long story short. A couple of years ago I started to feel a little short of breath for no reason my GP a youngish lady suggested an ECG which was carried out at the surgery mmmmmm she said I would like a Cardiologist to look at this and then the merry go round started !!

Next was an appointment to see a cardiologist, another ECG and then a Tread Mill, Echo then called back for an Angiogram.

After the angiogram the cardiologist came to the ward Hi Mr W you need to have some work done on your arteries ( sounded like my Dentist ) I will speak to you later. After about an hour he returned " had another look at the pictures you need surgery a triple bypass" I will put you to the surgeon with the shortest list I was gob smacked to say the least.

My wife couldn't get her head round to what we thought was just an investigation as to why I was becoming breathless without much exertion, to a full blown operation. So a bypass was carried out only a double because my RCA is occluded and can't be by passed.

Still a little breath less after the by pass which has been followed up by an MPS and a further Angiogram which has led to the decision to carry out a PCI to unblock the Right Coronary Artery. So I do feel I can help others with my positive experiences of the NHS and Heart Conditions

Depression is only a word I can type and spell, its not something I have experienced, stay positive and what will be will be.

Frank W aka Prada

[Hullensian]

Crikey, what experiences. Hope your move down south is "unpainful" - at least the weather will be warmer than Scotland. Every time we go to Scotland, even in summer, is rains and rains. Once went to a small village on the east coast which, we were told by the locals, has its own rain cloud. Began with an R (Rhu?) and nearby is a submarine base. My experience was similar to yours - although not as serious. Started with a dreadful cough at the beginning of December last year. Local media was informing everyone that lots of folks had a cough, not to go to the docs as it would eventually go. After 8 weeks went to the docs who told me, at first, there was nothing he could do, I didn't have an infection. However, I had a coughing fit just as I was leaving his room and he decided there may be some infection at the bottom of my lungs, and prescribed antiobiotics and I had a chest X-ray, which was clear. A month later, I went back at I was still coughing. I reiterated that I still felt tired and kept falling asleep if I sat down in the afternoon. So, more antibiotics and a "We'll send you for a 24hour ECG. There's nothing to worry about, it's just 'belt and braces'." Oh dear me, the next day I was wired up for 24 hours and the afternoon it they were removed I received a phone call that I had Atrial Fibrilation, that an Echio was booked for the following day. What a shock, just thinking I had a very bad cough. Anyway, as I said earlier, no-way as series as your experience. Godo Luck for the future.