# Apaxiban



## david k (8 Feb 2016)

on these at the moment, the doctor told me not to ride as its too dangerous, anyone else had this advice?


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## djmc (8 Feb 2016)

Apixaban is one of the NOACs - new oral anticoagulants. I take Xarelto alias Rivaroxaban, which is another. They are both substitutes for warfarin, and taken to avoid embolisms. In my case it is for atrial fibrillation. If when cycling you are likely to bleed because of it, then this might be the case, but I would think that he is being over cautious.


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## mrandmrspoves (9 Feb 2016)

I would guess that your doctor's advice is based on the medical condition that you have that requires anti coagulation rather than the anti coagulant itself - but that is only an (half) educated guess.......so if in doubt talk to your doctor or a pharmacist.


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## fossyant (9 Feb 2016)

If its for blood loss issues then don't worry as one of the British Pros (for Sky) is a haemophiliac and his issue is internal bleeding from breaks. He's managed OK.

If it's because of the underlying medical condition then seek docs advice.


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## ColinJ (9 Feb 2016)

I think (s)he may be worried about you falling off/getting knocked off and bleeding too much from your injuries!

I am on Warfarin for life and worried about the bleeding risk when I first started cycling again after having had the drug prescribed. I don't think about it now and just do what I always did pre-illness. The one concession I make is to wear a medical dog tag when out and about. It states that I am on the drug, and displays my NHS number, and two emergency phone numbers.


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## vickster (9 Feb 2016)

Ask the doctor why he has said that. In the meantime, best follow his advice


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## DaveGM (9 Feb 2016)

david k said:


> on these at the moment, the doctor told me not to ride as its too dangerous, anyone else had this advice?



I was on Apixaban for 12 months following an ablation for atrial fibrillation. I was not given any instructions with regards to avoiding any particular activities. In that time I rode a motorbike and used a chain saw in the garden!!

The other posters are quite right in that it is to prevent blood clots forming but on the other hand they carry a risk of increased bleeding which could include internal bleeding. Depending on your underlying condition, i am sure your doctors will have made a judgement on the balance of risks and benefits. I would guess that your doctor considered the possibility of an accident with perhaps a head injury?

I feel sure there are many people around the world on anticoagulants carrying on with activities much more hazardous than riding a bike!

Having said that I have no medical knowledge and would advise you to get further clarification from your doctor.


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## Markymark (9 Feb 2016)

I would get a second opinion from another doctor, not from idiots like me on the interweb.


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## david k (9 Feb 2016)

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!


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## Hacienda71 (9 Feb 2016)

fossyant said:


> If its for blood loss issues then don't worry as one of the British Pros (for Sky) is a haemophiliac and his issue is internal bleeding from breaks. He's managed OK.
> 
> If it's because of the underlying medical condition then seek docs advice.


 I think you will find he rides for Movistar now.


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## vickster (9 Feb 2016)

User said:


> You need a doctor who respects patient confidentiality.


Maybe the OP told her, or she goes to appointments with him?


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## david k (10 Feb 2016)

vickster said:


> Maybe the OP told her, or she goes to appointments with him?


She is my wife, I told her, maybe I could have left out some details ?


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## vickster (10 Feb 2016)

david k said:


> She is my wife, I told her, maybe I could have left out some details ?


Why should you?


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## mrandmrspoves (10 Feb 2016)

vickster said:


> Why should you?


.............So that she doesn't worry when you ignore your doctor's advice and continue cycling!


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## MartinQ (10 Feb 2016)

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 :-)


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## david k (10 Feb 2016)

vickster said:


> Why should you?


I was joking hence the smiley


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## Bazzer (10 Feb 2016)

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.


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## ColinJ (10 Feb 2016)

MartinQ said:


> 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.



Bazzer said:


> 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.


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## mrandmrspoves (11 Feb 2016)

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.


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## Bazzer (11 Feb 2016)

ColinJ said:


> 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.
> ...



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.


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## DaveGM (11 Feb 2016)

david k said:


> 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.


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## ColinJ (11 Feb 2016)

Bazzer said:


> 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.



Bazzer said:


> 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! _


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## david k (11 Feb 2016)

DaveGM said:


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


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


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## DaveGM (11 Feb 2016)

david k said:


> 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


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## Bazzer (11 Feb 2016)

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.


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## david k (11 Feb 2016)

DaveGM said:


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


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


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## DaveGM (11 Feb 2016)

david k said:


> 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!!!


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## ColinJ (11 Feb 2016)

Bazzer said:


> 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!


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## david k (12 Feb 2016)

DaveGM said:


> 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!


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## raleighnut (12 Feb 2016)

Bazzer said:


> 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)


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## Bazzer (15 Feb 2016)

raleighnut said:


> 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)



IIRC Enoxaparin (Clexane) every day for the 10 days I was in hospital and a 6 week stock when I was discharged. (And yes I took them as and when I was supposed to).
Hoping I don't get a repeat later this year as the consultant talked about discussing removing the metal work when I am next back to see him in August.


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## ColinJ (15 Feb 2016)

My sister and my niece have both broken bones in the past couple of years (foot/ankle). My niece needed surgery to insert metalwork to support the shattered bones. My sister made do with a plastercast. In neither case were they offered anticoagulation, which rather shocked me. I told them of the dangers of clotting so they both contacted their doctors and got put on Heparin. Since then, my sister has spoken to someone whose mother died from a blood clot after immobilisation with a broken leg. The woman had not been given anticoagulants either ...


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## Bazzer (15 Feb 2016)

I wonder if it is driven by the orthopaedic ward? May be some sort of risk assessment?
There were four of us in my bay who were longer stayers. We were all on Clexane from the day of our surgery. Others who were overnighters, or even up to four nights, didn't get injected and were not provided with anti coagulation medication, including one guy with a broken leg and and (same side) shoulder.


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## ColinJ (15 Feb 2016)

When I was in hospital the nurses routinely gave everybody Heparin. I was the only patient in the ward actually suffering from clots so I assumed that it was a preventative measure because the others also had very limited mobility and were spending prolonged periods in bed.


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## Yorksman (23 Feb 2016)

david k said:


> on these at the moment, the doctor told me not to ride as its too dangerous, anyone else had this advice?



I read this shortly before my wife took me to see the cardiology consultant. She is a haematologist and regularly runs the warfarin clinic. She said it would be to avoid damage to your head. If you bang your head and get an internal bleed, it will take longer to clot. The problem is you don't know whereas you do know if you cut your knee. You won't bleed to death, it just takes say twice as long to clot but, on the brain, that might be significant.

When I went in to see the consultant and asked him about it, he said immediately, wear a helmet and don't go too fast. It's a question of being sensible and you do have to take more care than most. However, even people not on Apixaban want to avoid head injuries and if anyone gets a bang, they should go to A&E. People forget, get carried away, race around corners or between the trees, jump their bikes off rocks or down concrete steps. It's all about managing risk. Slow down.


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## DCBassman (27 Apr 2018)

Yorksman said:


> I read this shortly before my wife took me to see the cardiology consultant. She is a haematologist and regularly runs the warfarin clinic. She said it would be to avoid damage to your head. If you bang your head and get an internal bleed, it will take longer to clot. The problem is you don't know whereas you do know if you cut your knee. You won't bleed to death, it just takes say twice as long to clot but, on the brain, that might be significant.
> 
> When I went in to see the consultant and asked him about it, he said immediately, wear a helmet and don't go too fast. It's a question of being sensible and you do have to take more care than most. However, even people not on Apixaban want to avoid head injuries and if anyone gets a bang, they should go to A&E. People forget, get carried away, race around corners or between the trees, jump their bikes off rocks or down concrete steps. It's all about managing risk. Slow down.


Just about to start on this (mild AF), so good to read the above. I wear a lid and don't (can't!) go too fast, soI'm doing it right, or will be when this damn shoulder heals. Will also consider some sort of MedicAlert tag if it's going to be long-term, which isn't certain yet.


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## david k (29 Apr 2018)

DCBassman said:


> Just about to start on this (mild AF), so good to read the above. I wear a lid and don't (can't!) go too fast, soI'm doing it right, or will be when this damn shoulder heals. Will also consider some sort of MedicAlert tag if it's going to be long-term, which isn't certain yet.


Thankfully I'm not on these anymore, managed to come off them. Still on blood pressure tablets though, although these obviously cause no issues as such


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