Changing Medication From Warfarin To Apixaban

[Clementino]

I have just received notification that I am suitable for changing my anticoagulant to a D.O.A.C. but on searching a number of sites, I note that some say there IS an antidote for reversing a bleed, and others say there is no antidote.

NHS are showing different results to gov.uk, but publication dates vary . I am awaiting a callback from the pharmacist who told me there is no antidote.

[Clementino]

I am wondering if any of you have any kind of knowledge or experience of DOAC 

[Peter Pedant]

yes- no - you wait until they stop bleeding.

yes you should change from Warfarin. 

yes I am on apixaban

yes someone else is on clopidogrel ( 'stronger') and is OK.

[Peter Pedant]

oh, yes 10 y - nothing happened but no blood tests!

yes I had a hickman line which they thought was infected ( temp 38.8'C) and so it was taken out to avoid acute sepsis and on apix, and yes I ended up without a hickman line ( ha!) and a haematoma from clavicle to xiphisternum

but so what?

[Clementino]

Peter, thanks. I will have to google most of what you have mentioned. Being new to the subject, I have not heard of a Hickman line 

[Clementino]

I am quite happy on warfarin, as the clinic is just a short walk from my home and my INR is tested every 6 weeks or so and if necessary, the daily dose (usually 2mg for 6 days and 1mg for 1 day) can be slightly altered if necessary. I just have to ensure I eat the correct amount of greens (vit. K)

[perseverer]

Speaking from  recent personal experience, I am on Edoxaban, I can say I was treated (successfully) to counteract  bleeding from a badly torn muscle, but it was done in Resus in A&E under very close monitoring over a period of about 90 minutes.

Obviously with prior knowledge of a procedure, you can stop the daoc in advance, but there is a difficulty in an emergency and it is important you carry a warning card and family etc are aware.

[calmck]

Do you mean that you are actively bleeding or is your INR high. The usual treatment is to stop the Warfrin, monitor the INR and reassess. 
There is no specific antidote for Warfrin as such but there are treatment options.

i have had no problems with Apixiban. Frequent INR tests are not needed

[Clementino]

Perseverer, thanks. I dread the thought of ending up in resus. I have been there twice in the past for AF but that was years back. If poss. I would rather stay on warfarin 

[calmck]

A Hickman Line is a special intravenous line inserted into a large vein ,often the subclavian. It is used for chemotherapy or special nutrition and blood can be taken from it. It must be kept as sterile as possible

[Clementino]

calmck. I am not sure if your question was for me or 'perseverer  My INR is usually spot on

[calmck]

The newer anti-coagulants are more in favour and cause less problems and are preferred for long term use

[calmck]

I don't understand why you are asking about an antidote then

[Clementino]

Thank you all. I know I am a bit of a coward and am just frightened of a bleed. I will think carefully of what you all have said  x

[Peter Pedant]

calmic has been watching too much casualty

Warfarin is reversed with vit K ( but  then you cant restart it for a few weeks) - Hickman lines, any central vein - mine was internal jugular.

 There is currently no reversal agent or antidote for rivaroxaban or apixaban.

I thought I better check. ie you just wait- for smaller procedures such as tooth extraction, "you just do it" - dentist looked a bit shockerd at that