Apixaban for atrial fibrillation

What is atrial fibrillation?

Atrial fibrillation is a heart condition that causes irregular heart rate, which is often unusually rapid.

Your heart is a muscle. It has four chambers; left and right atria (upper chambers) and left and right ventricles (lower chambers).

The atria send electrical signals that cause your heart to beat and the ventricles pump blood to your lungs and around your body.

The atria

Within your atria is a group of cells called the sinus node. This is your heart’s natural pacemaker, it sends small electrical signals which cause the heart to contract at even and consistent intervals, and trigger your heartbeats.

If you have atrial fibrillation

The electrical signals are chaotic and this disturbs your heart’s natural rhythm. As a result, the atria will not contract properly and your heart cannot pump blood as efficiently as usual.

Blood clot

Because blood is not being pumped efficiently, this can sometimes cause blood to pool in the atria and form a thick blob (blood clot).

If this happens and a clot, or bits of a clot, break loose, they can travel through your bloodstream. If a clot blocks blood flow to your brain, it may cause a stroke. This is why your doctor may prescribe treatment to reduce this risk.

Atrial fibrillation and risk of stroke

The condition itself is not usually life-threatening but the risk of stroke can be increased by up to 5 times. A stroke is a serious medical emergency and will need urgent hospital treatment. The sooner you receive medical treatment for a stroke, the less damage it is likely to cause.

Signs and symptoms of stroke are:

• Weakness or numbness on one side of your body.
• Facial drooping and muscle weakness that affects your eyes, lips and mouth.
• Slurred speech.
• Unable to understand what others are saying to you.

Taking apixaban

You will have been advised to take apixaban twice a day. For example, one tablet in the morning and one in the evening. Try to take the tablets at the same times every day.

Swallow the tablet with a glass of water with or without food.

If you have difficulty swallowing the tablet whole, discuss this with your GP.

Missed dose

If you miss one of your doses of apixaban, you should take it as soon as you remember if it is still more than 6 hours until your next dose. If it is less than 6 hours until your next dose, skip the dose you have missed and take the next dose as normal.

If you miss more than one dose, ask your GP or pharmacist for advice.

If you take more than the recommended dose of apixaban, you must seek immediate medical attention from your GP or NHS 111 as you may be at an increased risk of bleeding.

Signs and symptoms of atrial fibrillation

Many people do not experience any symptoms. However, those who do have symptoms may feel:

• Tiredness or exhaustion
• Shortness of breath
• Palpitations (heart racing which can be uncomfortable)
• Chest pain
• Weakness
• Faint, dizzy or lightheaded
• Less able to exercise

Please be aware that these symptoms may also be associated with other conditions such as anxiety. Therefore, they may or may not be a sign of atrial fibrillation.

Possible side-effects of apixaban

Like all medicines, apixaban can cause side-effects for some people. These include:

• Increased bleeding risk
• Anaemia
• Feeling sick

You may also bruise more easily when taking apixaban. If you notice a very large bruise that appears for no reason or widespread bruising that you cannot account for, please let your GP know.

Bleeding can happen in different parts of your body such as your nose, gums, urine, stools, lungs, throat and vagina.

An example of minor bleeding would be your gums bleeding when brushing your teeth.

A more serious example would be the presence of blood in your urine, vomit or stool.

Apixaban is not recommended in:

• Pregnancy and breastfeeding.
• Patients with prosthetic heart valves (with or without atrial fibrillation).
• Patients taking certain medicines as listed in the patient information leaflet within the medication pack.
• Patients who are at the end stage of renal disease or who are having dialysis.

Tell your GP if you have a condition called antiphospholipid syndrome (a disorder of the immune system that causes an increased risk of blood clots).

You should not take apixaban if you:

• are allergic to any of the ingredients listed on the pack.
• are bleeding excessively.
• have or you are thought to have a condition that increases your risk of bleeding.
• have liver impairment with increased risk of bleeding.
• are taking medicines to prevent blood clotting.

Things to be aware of

• Inform your GP, pharmacist or dentist that you are taking apixaban when having any surgical or dental procedures. Apixaban may need to be reduced or temporarily stopped.
• You must also inform your GP or pharmacist if you are taking other medicines not prescribed or supplements as they may interfere with the anticoagulant effect of apixaban.

It is important that you look out for any signs of bleeding.

Healthy living with atrial fibrillation

You should consider the following lifestyle factors if you have atrial fibrillation:

Diet

• No dietary restrictions are required when you are taking apixaban. However, a healthy diet can reduce other risk factors that contribute to atrial fibrillation and stroke.
• You should avoid high amounts of fatty meats and processed foods to help control your cholesterol levels.
• Include fresh fruits and vegetables as part of your diet.
• Reducing your salt intake can help to control high blood pressure.

Exercise

You can still exercise or continue your regular physical activity. This will help with your weight control but can also help you to maintain a positive outlook. Consult your GP before you start any new forms of exercise to decide if it is suitable for you.

Further information

Support is available from Gloucestershire Healthy Lifestyles. Visit the website below for more information:

Website: www.hlsglos.org