Apaxiban

[david k]

Why should you?

I was joking hence the smiley

 

[Bazzer]

Been on warfarin since last September following discovery by physio of a blood clot following my off and double femur break in July. Consultant who operated, physio, hospital staff who saw the clot on a scan, GP and the warfarin clinic staff all know I ride. Never been told not to ride despite INRs up to 3.8 and all INRs apart from initial warfarin use, of >2.5.
Apart from the regular questions at the warfarin clinic about unusual bruising or bleeding, there has been no interest by medical staff. In fact my eldest daughter showed the greatest concern by making me wear a "warfarin user" bracelet, just in case I had another off.

 

[ColinJ]

On Xarelto as well. Sounds like your doc is being far over cautious. If you come off, you do bleed a bit more, so pack a few wipes / large plasters. Relating it to warfarin, you'll bleed for twice as long as normal, it doesn't mean that it's going to kill you if you have an accident.
I wear a lid as your head does bleed a bit more. I wish I had when worn one when I was chopping down a tree and stood underneath it when cutting down a particularly large branch :-)

I dropped an empty jar on my kitchen floor. I thought I'd picked up all the pieces but I must have missed one small piece which ended up stuck to the bottom of one of my cycling socks. I hardly felt it while I was out on the ride (I thought I just had a small stone in my shoe so I didn't bother stopping) but when I got home my sock was soaked in blood. That is one of the few times that I have noticed my extended bleeding time on warfarin.

Been on warfarin since last September following discovery by physio of a blood clot following my off and double femur break in July. Consultant who operated, physio, hospital staff who saw the clot on a scan, GP and the warfarin clinic staff all know I ride. Never been told not to ride despite INRs up to 3.8 and all INRs apart from initial warfarin use, of >2.5.
Apart from the regular questions at the warfarin clinic about unusual bruising or bleeding, there has been no interest by medical staff. In fact my eldest daughter showed the greatest concern by making me wear a "warfarin user" bracelet, just in case I had another off.

Bazzer - 3.8 is a bit on the high side - are you getting enough vitamin K in your diet? The old medical advice used to be to minimise it when on warfarin because "it works against the drug". Recent research (READ THIS) suggests that the main thing is to be fairly consistent in your vitamin K intake, and eating a reasonable amount helps to stabilise your INR. The clinic will adjust your warfarin dose up a bit if your increased vitamin K intake lowers your INR too much.

I nearly always achieve 2.3 <= INR <= 2.7.

 

[mrandmrspoves]

INR may not be too high Colin. Although most Warfare users are aiming for an INR of about 2.5 - the INR range is set according to the individual's perceived risk of developing a further blood clot. Don't see them much any more - but as an example patients who had been given mechanical heart valve replacements were normally aiming for an INR of about 4.5. INR dosing is aimed at getting the best balance between risk reduction from blood clots and increased risk of haemorrhages - it's still not an exact science because risk cannot always be accurately measured.

 

[Bazzer]

I dropped an empty jar on my kitchen floor. I thought I'd picked up all the pieces but I must have missed one small piece which ended up stuck to the bottom of one of my cycling socks. I hardly felt it while I was out on the ride (I thought I just had a small stone in my shoe so I didn't bother stopping) but when I got home my sock was soaked in blood. That is one of the few times that I have noticed my extended bleeding time on warfarin.


Bazzer - 3.8 is a bit on the high side - are you getting enough vitamin K in your diet? The old medical advice used to be to minimise it when on warfarin because "it works against the drug". Recent research (READ THIS) suggests that the main thing is to be fairly consistent in your vitamin K intake, and eating a reasonable amount helps to stabilise your INR. The clinic will adjust your warfarin dose up a bit if your increased vitamin K intake lowers your INR too much.

I nearly always achieve 2.3 <= INR <= 2.7.

Colin
3.8 was the highest it has been. From the outset they have been aiming for for the range 2 - 3 and would prefer it to be around 2.5 - 2.6 , but that was only achievable when I was on crutches. Since I have been off them, 2.5 has been the minimum, but typically I am around 3.1 - 3.3 despite a consistency in diet. I can have the same dose between visits to the clinic and wildly different readings. E.g. on three visits I went from 3.0 - 2.6 - 3.6, all with the same dose. So as long as the reading doesn't get too high, with the history of my readings, they don't get too concerned.
As for bleeding, apart from one time when I lifted about a 2 sq cm of skin from a finger when lifting a built in cooker, which resulted in a bit of a mess, I haven't (so far) had problems. Plasters, (when needed) on the cuts and nicks of (my) everyday life, seem to quickly resolve matters.

 

[DaveGM]

Taking it for AF and yes he said it's because of the bleeding risk, I have just been riding indoors since, thought it may be over cautious but thought I'd ask if others had same advice

The wife know his advice so I'm unlikely to get out on the bike as I'll get lots of grief, I think the doctor is over cautious but try telling my wife!

David

Was the advice from your GP,Cardiologist or Electrophysiologist (Cardiologist who specialises in rhythm problems)?

In my experience GP's don't know that much about AF and Cardiolgists are the heart "plumbing" specialists.

If the advice is from an Electrophysiologist than fair enough, if not I would recommend you get referral to one and see what he says.

Hope this helps a bit.

 

[ColinJ]

Colin
3.8 was the highest it has been. From the outset they have been aiming for for the range 2 - 3 and would prefer it to be around 2.5 - 2.6 , but that was only achievable when I was on crutches. Since I have been off them, 2.5 has been the minimum, but typically I am around 3.1 - 3.3 despite a consistency in diet. I can have the same dose between visits to the clinic and wildly different readings. E.g. on three visits I went from 3.0 - 2.6 - 3.6, all with the same dose. So as long as the reading doesn't get too high, with the history of my readings, they don't get too concerned.

Hmm, it's a bit odd that they haven't reduced your dose to get your readings down a bit! If they got you down by (say) an average of 0.6 then you would be typically 2.5 - 2.7 and those 3 readings would have been 2.4 - 2.0 - 3.0 which would all have been in the proper therapeutic range. of 2.0 - 3.0.

The staff at my clinic have been very helpful when I contacted them. I asked to be tested more frequently for a while because I wanted to change my diet and start taking some supplements which might have affected my INR. They tested me every 2 weeks until they were sure that I was ok, then they gradually increased the interval between tests back to 10 - 12 weeks.

As for bleeding, apart from one time when I lifted about a 2 sq cm of skin from a finger when lifting a built in cooker, which resulted in a bit of a mess, I haven't (so far) had problems. Plasters, (when needed) on the cuts and nicks of (my) everyday life, seem to quickly resolve matters.

OUCH!

 

[david k]

David

Was the advice from your GP,Cardiologist or Electrophysiologist (Cardiologist who specialises in rhythm problems)?

In my experience GP's don't know that much about AF and Cardiolgists are the heart "plumbing" specialists.

If the advice is from an Electrophysiologist than fair enough, if not I would recommend you get referral to one and see what he says.

Hope this helps a bit.

It's was from the cardiologist, but I'm in the hospital in a couple of weeks so will ask again.

Next appointment is at a specialist heart hospital, the one in Liverpool to look at options

 

[DaveGM]

It's was from the cardiologist, but I'm in the hospital in a couple of weeks so will ask again.

Next appointment is at a specialist heart hospital, the one in Liverpool to look at options

David

LHCH? Thats where i had my ablation carried out in june 2014.

Excellent place, very good electrophysiologist who I would recommend to anyone.

Good luck

PS If you want any detailed info - don't hesitate to ask

 

[Bazzer]

Colin
I think if the treatment it was for a heart condition, they would be more concerned and I would be more actively managed. There have been variations of doses throughout the process, but the readings still go all over the place.
All being well I'll have a scan this month to see what is happening to the clot.

 

[david k]

David

LHCH? Thats where i had my ablation carried out in june 2014.

Excellent place, very good electrophysiologist who I would recommend to anyone.

Good luck

PS If you want any detailed info - don't hesitate to ask

Is that the one next to the Royal? If so that's the one, is there parking do you know pls?

 

[DaveGM]

Is that the one next to the Royal? If so that's the one, is there parking do you know pls?

No The Liverpool Heart and Chest Hospital (LHCH) is at L14 3PE and that as I understand it is where all the experts in arrhythmias are based. There are at least 6 electrophysiologists based there who carry out ablation procedures and it is considered to be the right place to go.!!

I am not trying to advise you, but if you want to get back on the bike this would be my first port of call.

Please don't get me wrong as I was not a cyclist before I came across AF. More a case of being advised to take some exercise after a successful ablation - so I bought a relatively cheap bike form Halfords last August and enjoying it so far!!!

 

[ColinJ]

Colin
I think if the treatment it was for a heart condition, they would be more concerned and I would be more actively managed. There have been variations of doses throughout the process, but the readings still go all over the place.
All being well I'll have a scan this month to see what is happening to the clot.

Oh well, at least they know what caused the clot and it is (hopefully) unlikely to happen again unless you have another accident. Good luck with the scan!

 

[david k]

No The Liverpool Heart and Chest Hospital (LHCH) is at L14 3PE and that as I understand it is where all the experts in arrhythmias are based. There are at least 6 electrophysiologists based there who carry out ablation procedures and it is considered to be the right place to go.!!

I am not trying to advise you, but if you want to get back on the bike this would be my first port of call.

Please don't get me wrong as I was not a cyclist before I came across AF. More a case of being advised to take some exercise after a successful ablation - so I bought a relatively cheap bike form Halfords last August and enjoying it so far!!!

That must be the one then, I believe it's not to the Royal?ill check it out I have a letter, need to read it!

 

[raleighnut]

Been on warfarin since last September following discovery by physio of a blood clot following my off and double femur break in July. Consultant who operated, physio, hospital staff who saw the clot on a scan, GP and the warfarin clinic staff all know I ride. Never been told not to ride despite INRs up to 3.8 and all INRs apart from initial warfarin use, of >2.5.
Apart from the regular questions at the warfarin clinic about unusual bruising or bleeding, there has been no interest by medical staff. In fact my eldest daughter showed the greatest concern by making me wear a "warfarin user" bracelet, just in case I had another off.

Did they not stick you on Dalteparin after the op to prevent clots, I was on it for 6wks after both of mine (they inserted an intermedullary nail to fix the break but after 8 months of the break not healing removed it, drilled/reamed the inside of the bone and inserted a bigger pin)