Edoxaban and INR

[Flip70]

I found out i have AF and HCM 6 weeks ago, i have been on Edoxaban and bisoprolol for 5 weeks awaiting a cardioversion.

I was told I needed a blood test for kidney and full bloods. I had to ask for a INR to be added.

A Dr just rang me asking why I had an INR test as I'm not on warfarin. Felt like I was getting told off. Then tells me it's only 1.3 and should be above 2. Tells me he doesn't know what to do as I'm on Edoxaban, and to have another test.

Would a INR of 1.3 stop me from having cardioversion?

[Bagrat]

My understanding is that Edoxaban works on a different part of the clotting cascade which is a complex system. Edoxaban although an anticoagulant, does not affect the INR in a consistent way so this has no bearing on your having a cardioversion. Different centres require you to be on anticoagulants for different periods of time prior to cardioversion. It is therefore the length of time you have been taking Edoxaban without missing any doses that is important

I'm surprised the doctor didn't know that. An INR is, as far as I'm aware only used to assess warfarin control not the Novel anticoagulants such as the one you're taking.

You may like to look at the Atrial Fibrillation Association group as well as this one. Lots of good info on their main site too as well as BHF

I know NOACs can affect INR but the effects are variable so it is not used as a test of efficacy.

[not2worry]

Here in the States they will only do a carioversion if your INR has been stable between 2-3 for 30 days.

I believe it is standard practice in that while the procedure is non invasive it is a jolt to every system in your body and the last thing they want is a blood clot shaking loose and creating a stroke or worse.

[Bagrat in reply to not2worry]

You may fi d this interesting. ncbi.nlm.nih.gov/pmc/articl...

The specific quote re INR is this

"INR was specifically developed for monitoring VKA therapy, and therefore, point-of-care PT/INR testing (CoaguChek®) is not recommended for assessing the anticoagulation intensity of DOACs." DOACS and NOACS same thing

[not2worry in reply to Bagrat]

Thanks for the article. Yes the new VKA therapies sound great but it seems they really require more patient education and the “you don’t have to monitor” your INR seems somewhat of a fallacy after reading this report. My husband’s cardiologist prefers Warfarin. It can be monitored with the CoaguChek and is kinder to his kidneys. He’s been on it for 2 years now and his INR has stabilized between 2-3. When it bounces up or down we usually know why-traveling, taking antibiotic, holiday eating, etc.

[Challiefan]

I believe INR checks are only needed if you're on Warfarin. The readings have to be stable, and within range to proceed with Ablation. e.g. INR tests whilst I was on Warfarin before Ablation. None since I've been on the anti-coagulant Rivaroxaban.

[Flip70]

Thanks everyone, I have spoken to the cardiac investigations team and they have confirmed that Edoxaban works differently to warfarin.

No INR needed, just have to take the pill everyday.

I need at least 3 weeks before they will do the cardioversion.