Hi i've found this -
anything is possible,
realistically, have you had a close look at the official side effects taking apixaban? Have you been compliant? Is there an antidote to neutralise any side aeffects?
Below is not related to apixaban, but there are other anticoagulants that may have an effect on short term liver function for those that don't drink alchhol when they are seriously ill.
Maybe the posology & contraindication of NOACS & other traditional anticoagulants have not been thouroughly thought through, trialed and tested. That's why regulation and monitoring is an important issue when concerned with patient safety and wellbeing.
There may be a direct relationship between the function of the liver and types of heparin administered. I'm a patient with access to credible sources of info.
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This is from google:
Unfractionated heparin (UFH) as a pharmaceutical is heparin that has not been fractionated to sequester the fraction of molecules with low molecular weight. In contrast, low-molecular-weight heparin (LMWH) has undergone fractionation for the purpose of making its pharmacodynamics more predictable.
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This is from a credible confidential source - but it does not mention liver function monitoring timeframes when prescribed combination dosages of NOACs & Heparin (LMWH).
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Treatment of DVT and PE: 2. Unprovoked and Recurrent DVT and PE
Patient weight is used as the basis for calculating the treatment dose of dalteparin and should be accurately recorded on the prescription.
Dalteparin should be prescribed, with the first dose administered as soon as a diagnosis of probable DVT/PE is made. EXCEPT:
when there is a contraindication to dalteparin therapy (see below) AND
in acute massive PE in which there is insufficient evidence for its use. Here, alteplase may be appropriate followed by IV unfractionated heparin (IV UFH).
Monitoring Requirements when using Heparin or Dalteparin Platelet count should be monitored at baseline and weekly thereafter.
Development of heparin-induced thrombocytopenia does not usually occur until after 6 to 10 days. In patients whose platelet count falls by 50% compared to baseline, heparin should be stopped. Baseline clotting screens are useful if there is a major medical illness or a coagulopathy anticipated.
Hyperkalaemia may occur via heparin-induced inhibition of aldosterone secretion. Potassium levels should be monitored at baseline and weekly thereafter in patients at risk of heparin-induced hyperkalaemia. These patients include those with diabetes mellitus, chronic renal impairment and pre-existing metabolic acidosis.
Prescribing outside this formulary should only take place via a New Product Request
Risk Factors for Bleeding:
• Acute stroke in previous month (haemorrhagic or ischaemic)
• Untreated inherited bleeding disorders (such as haemophilia and von Willebrand’s disease)
• Uncontrolled systolic hypertension (230/120 mmHg or higher) • Severe liver disease (prothrombin time above normal or known varices)
• Major bleeding risk, existing anticoagulant therapy • Lumbar puncture/epidural/spinal anaesthesia within the previous 4 hours or next 12 hours.
• Thrombocytopenia (platelets less than 75 x 109 /l)
• Active bleeding
• Neurosurgery, spinal surgery or eye surgery
Heparin Flushes
Lumens in continuous or daily use do not usually require flushing to maintain patency, but a ‘Saline-Additive-Saline’ method should be employed during any administration of an additive.
Long-term central intravenous catheters used for intermittent drug administration (such as Hickman lines) should be locked weekly with 5ml of heparin 50unit/5ml (e.g. Hepsal/Heplock) when not in daily use.
In other situations where a central lumen may be anticipated not to be in continuous or daily use, heparin 50units/5ml may be used to flush the line and lock the line.
In all circumstance the use of the flush must be documented by being
prescribed prior to administration or,
documented in the patients’ clinical record if the flush is administered by the prescriber who initiates therapy.
Administration of heparin should be checked in accordance with the Policy for the Safe and Secure Handling of Medicines