Abnormal Liver Function Tests

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Dear All,

I was invited to attend my Doctor's Surgery to discuss the results of my liver function tests, which were abnormal.

I am new to this GP's Surgery and was seen by the Practice Nurse to discuss the abnormal results. The first question that I was asked was 'Do you drink a lot'?

I do not drink to excess, but am overweight.

I explained that I am taking Apixaban, which then set alarm bells ringing. I have been taking Apixaban for approximately 18 months now and last year's Liver function tests were fine.

I will be repeating the tests in a month;s time, in which I will have stopped drinking anything alcoholic.

Is it at all possible that Apixaban might be responsible for the abnormal results?

Many thanks!

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11 Replies

  • Posted

    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.

    _____

    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.

    ____

    This is from a credible confidential source - but it does not mention liver function monitoring timeframes when prescribed combination dosages of NOACs & Heparin (LMWH).

    ____

    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 

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    • Posted

      Wow! Many thanks for providing such an informative and thought provoking response!

      I am having my liver function test repeated in a month and will eradicate alcohol and lose some weight in an attempt to see if this has any impact on the next round of results!

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    • Posted

      Hi, it sounds like a good idea. In the interest in learning more about yourself, and adapting to change in lifestyle as a 'clottie', you got to conclude if losing weight or change in water retention in your viscera, body fat , or muscle tissue has an effect on your liver function.

      Or it could be down to alcohol or other toxins produced or administered. I have found out the warfarin and alcohol may not mix well together, but in the long run maybe warfarin works out cheaper, and allows freedom to allow diet, exercise and lifestyle to produce stable blood whilst monitoring.

      I hope & believe, once lifelong patients are scientifically verified stable and willing, the transition to warfarin & (alcohol free life) for lifelong anticoagulation could open up holistic lifestyle regulation of sticky blood and possibly prevention. I hope.

      I am a NHS customer, I think reduced cost burdens within the prescription service will please the general public, taxpayer and organisation as a whole.

      Further R&D can open up avenues and channels that may facilitate prevention, well-being & care, disability cost management , and optimized lifestyle cures for certain groups of people.

      Some people may not agree with my way of thinking, but I can't help being the way I am with unprovoked recurring VTE.

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    • Posted

      Thanks for sharing your thoughts - which I appreciate and am extremely receptive to!

      My previous clotting episodes, commencing in 1999 following major surgery to my knee that resulted in a 'provoked' DVT in my right calf, were followed by a number of DVT's and three PE's.

      I was always treated with Warfarin, until my latest PE in November 2014, when it was decided to switch me to one of the NOACS.

      (Apixaban).

      Warfarin, although cheaper, has many limitations. Majority of food groups interact with its function, as does alcohol and other drugs.

      I am receiving conflicting reports about alcohol and Apixaban. Some say it is fine, others advise to proceed with caution. I am not a heavy drinker, but do enjoy a beer!

      Whilst I wish that I did not have to take lifelong anticoagulation, I have to temper this by believing that they are potentially keeping me alive!!

      I am on a quest to find a balance that maintains optimum health and will certainly research potential holistic alternatives!

      Any research findings that I come across I will share!

      Kindest regards!!

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    • Posted

      Hi nigel0151, I want to learn more, pls see below in brackets (*"':;!!)

      My previous clotting episodes, commencing in 1999 following major surgery to my knee that resulted in a 'provoked' DVT in my right calf, were followed by a number of DVT's and three PE's.

      (1.

      Do you know if the provoked DVT, and subsequent DVTs and three PEs are connected to the major surgery? ie, from the same leg, potential compliance/ dosage/ exercise issue with warfarin?

      2. Are you privy to your scans, hopefully if there are any)

      I was always treated with Warfarin, until my latest PE in November 2014, when it was decided to switch me to one of the NOACS.

      (

      I would have thought 15years is enough time for your body's immune system to identify and dissolve any residual clots in your body.

      I think it's important to identify the VTEs and be mindful of its/they're dissolving/ scarring* progress. It must have been a proper shock to you m8, physically and emotionally draining.

      May I ask if you do anything out of the ordinary prior to your PE in November '14? Your faith in warfarin must have been shattered at the time.

      I think CTPA scans, blood tests, ECGs etc are like a comprehensive checkup for 'VTE patients, they reveal ones inner circulatory mechanics.

      )

      My own analogy of scans .. is bit like a cross between an MOT on a car and x-ray vision spotting an issue with central heating pipeworks, radiators, valves, pumps, controls sensors and wiring.

      I find it fascinating as I really want to know what's going on inside my own body. I am on lifelong anticoagulation- for me, it's like being a prisoner in your own body having a clot as your cell mate occasionally reminding you of it's presence; and all the entails with it.

      I know everyone is different, I hope this area of medicine has not matured yet, I believe and think there is lots of scope for theoretical improvement in the management of VTE in all patients, in and out of hospital.

      I can stake my life on it.

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    • Posted

      Hi,

      Happy to respond to your questions as below:

      All on my subsequent DVT's have all been in the same leg (right calf). According to the Consultants, I have been 'unlucky' as their investigations and screening confirmed no hereditary or genetic reason for the DVT's and subsequent PE's.

      It would appear that the one DVT that they could explain was when I was in thigh length plaster in a hospital ward post my surgery.

      I am not privy to any of my scans,

      Consultants always considered placing me on life long Anticoagulation but stopped short of this due to my relatively (at the time) young age!

      Prior to my PE in November 2014, I was not doing anything unusual, nor was I taking any anticoagulation.

      I was initially placed on Warfarin, but the management of my INR was proving difficult - plus, I was suffering with extremely itchy legs!!

      I have PTS in my right leg now. (Post Thrombotic Syndrome)!

      I would have thought that my own immune system would have been equipped to deal with any further clots, but apparently not!

      I do feel emotionally scarred, but at least I am now taking more interest in my own body and how it all works!

      Forums such as this are extremely useful.

      Thank you for your interest!

      Best wishes

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    • Posted

      Hi nigel0151, 

      after a quick look & read on google/images my first reaction is maintaince the integrity of your existing circulation in BOTH your legs, infact all your limbs.

      Good diet & hydration,

      VTE led physiotherapy needs to be developed for all ages, sex/~gender.

      The quintessential focus is relaxation of the damaged deep vein & strengthening of valves (hard & soft).

      Try not to encourage mechanical leverage to increase bloodflow - ie external weight training/impact exercises - (that's my own opinon),

      i believe that would direct internal physical stresses and tension at the bottleneck/weakened points - maybe a localised bio-chemical reaction/process starts - ie a localised mutation in DNA> one's internal energies influencing the type of tissue generation/repair during recovery-deviating from ones original genetic blueprint - path to 100% repair & 100% recovery - (my theory) 

      'Blood & energies' will want to flow through paths of least resistance, bypassing/or reducing volume at veins/capilliaries optimum capacity as per original design. The reduced blood volume carries less nutrition aiding recovery ensuing a cycle of malnutrition. The reduced energy flow depletes energy to affected cells & tissue & structural intergrity of DNA (my theory) 

      Emotional scarring is mapped with the physical & mental trauma of VTE, and is triggered by duplicity of stresses & anxieties reminicent of them frail times> you move on, in your own way, in day to day life> endocrine response/ excess hormone & hormone rebalancing> optimum hormone levels > the duplicity of experiences is registered in different conscious levels because of the nature of VTE - pulse, breath & thoughts.

      With experience, repitition comes confirmation - I hope it's not confirmation bias- technical anlaysis, scans & ECGs provide a body of knowledge for those sensitive & interested in this area.

      Emotional scarring - the 'fear=fight/flight response' matures to a curiosity=fight/flight response when I faced my own mortaility on several occations, creating further mapping/trigger points with subsequent PE/pains/symptoms/ stresses & anxieties - it has been overwhelming for me - pushing me to the limits of my constitution, outlook in life - meaning of life, purpose in life and point of life.

      Emotions can be healed through learning. The physical, bio-mechanical aspect takes time and doesnt happen over night or upon discharge after discharge.

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    • Posted

      Your advice is indicative of a knowledgeable person, who has experienced similar clotting episodes to mine.

      I appreciate the impact that emotions can have on the body. Every episode of pain, particularly chest pain, resulted in my feeling that 'the end was nigh' ! I insisted that I was given every possible heart test to rule out potential heart problems, including tests for pulmonary hypertension.

      Thankfully, all negative!

      You have set me on a journey, whetting my appetite for more information. I need to heal, both physically and emotionally.

      For that, I thank you!

      Leading up to my next liver function test in a month's time, I intend to be alcohol free, lose a bit of weight and focus more on my diet.

      I do feel that my Apixaban is the cause of the abnormal liver test results. We shall see!

      Do share any additional information that comes your way!

      Best of luck to you!

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    • Posted

      Good morning nigel0151,

      A couple of questions, in your experience,

      Do you think it is possible to have mental health wounds as a consequence of the repetitive physical & emotional aspects of recurring VTE? 

      Could day-to-day real-life issues and VTE stakeholders directly & indirectly contribute to emotional+ physical stresses of a vulnerable patient, thus affecting a persons MH?

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    • Posted

      Dear A Way Forward,

      I would say that my experience did leave me with mental wounds. I could not stop thinking about my own mortality, became frightened and worried about the impact on my wife, children and immediate family.

      There were times that I felt scared about going to sleep at night. Every twinge of chest pain caused me to think 'Is this it'?

      No that it apprars that my clotting is 'allegedly' under very close control, my fears have lessened, but not sure if I am the same person pre my clots!

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    • Posted

      You seem to be very knowledgeable about anticoagulation therefore I wonder if you can give me the benefit of your thoughts.

      unprovoked dvt 15 years, resolved clexane after 6 weeks.

      spinal surgery 3 years ago, six weeks later miltiple,p.e.s. 

      Now on warfarin probably for life but dr suggests apixaban may be better as it saves all the INR tests. No further events.

      i am concerned about side effects and there is no doubt my MH has suffered after the p.e.s. 

      Just want to do the right thing for my body.

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