Abnormal bowel screening test

Hi

have been referred for colonoscopy because of abnormal test result with bowel screening (uk) 
As I take Lixiana for a fib, is it possible the anti coagulation drug caused blood in the stool?

I also have a pacemaker


8 Comments

Colonoscopy

by Gemita - 2022-11-01 10:45:07

Loonylil (and I am sure you are not loony),

I also take Lixiana for Atrial Fibrillation.  I am also in the UK.  The only way to be sure that you are not suffering from bowel disease is to directly look at the colon and a colonoscopy (unfortunately) is the gold standard investigation.  If something is found, like a polyp, it can be removed at the same time.  It is better to be safe than sorry.

Yes of course it is possible that Lixiana may cause gastric bleeding, but only a colonoscopy can confirm what is happening, or rule out anything serious.  

The preparation is the worst part.  Make sure you have someone go with you to the hospital since bowel preparation and arrhythmias may not mix.  Also, drink lots of water to prevent dehydration.  I wish you lots of luck and a clean bill of health.

As a footnote, both my husband and I take 30 mg, once daily Edoxaban (Lixiana).  My husband is over 80 and has kidney disease.  I am under 60 kg in weight.  We both therefore qualify for a lower dose which is still apparently protective against an AF related stroke.  At this dose, we have not experienced any problems.  The colonoscopy will give your doctors a lot of information if any blood loss is due to Lixiana

Prove that you're not a Loony, Lil.........

by IAN MC - 2022-11-01 11:39:20

........ and have that colonoscopy a.s.a.p.

Most rectal bleeding has a relatively simple cause such as constipation or hemorrhoids but it can be the first indication of a serious underlying medical  condition.

Edoxaban would certainly worsen the symptom , and could even cause it.

Best of luck

Ian ( also in the UK )

Thank you both for the helpful response

by Loonylil - 2022-11-01 12:12:46

Thanks for the comments, I am interested in Gemmita's dose of Edoxaban, as I weigh 55 kg and take 60gm of the medication.

I have wondered if it's too high?
I will go for the colonoscopy and keep your info in mind to ask questions !

Thank you for being there

Edoxaban, Low body weight - below 60 kg, recommendation is 30 mg

by Gemita - 2022-11-01 12:42:21

Loonylil, Yes I was under an anticoagulation clinic team at the time Edoxaban was prescribed.  I switched from Apixaban twice daily dosing, to once daily dose of Edoxaban 30 mg because of low body weight.  I have been on Edoxaban for over 4 years (same for my husband) with no problems at all and more importantly, no strokes.  There may be a reason why you are on 60 mg Edoxaban, but it is worth asking your doctors if you would qualify for the lower dose?  It would certainly be better tolerated and less likely to cause a bleed. 

Edoxaban

by Loonylil - 2022-11-01 14:06:58

Hi Gemmita

many thanks for your comments. I have wondered for a while about the dosage, I was originally prescribed Warfarin but couldn't keep the inr level so GP changed it.

I think it definitely needs exploring! Best wishes

Don't Skip That Colonoscopy

by Marybird - 2022-11-01 16:11:23

In answer to your question, as I have read, been told and experienced myself, anticoagulants such as Edoxaban and Apixaban ( Eliquis) do not themselves cause bleeding, but may well enhance bleeding that is already occurring anywhere in the body.

That said, here's my cautionary tale.....

I have A-Fib and take Eliquis ( 5mg twice a day) for stroke prevention. I have no problems with bruising, excess bleeding, or any other problems with Eliquis. But we found a significant drop in my hemoglobin over a 6 month period ( over two grams). I was found to be severely iron deficient, several fecal occult blood results were positive, and I was referred by my GP for endoscopies ( upper and lower) to find that bleeding source.

The colonoscopy showed a large bleeding tumor in my transverse colon ( near the hepatic flexure)- an adenocarcinoma, the biopsy said. This came as a complete surprise ( and shock) to all of us, the doctors, me, my family as we have had no history of colon cancer in my family, and I had had a colonoscopy four years ago ( 2018) which was clear, not even sure there was a polyp in there, and the doc had said to come back in 10 yrs.

But there it was, I had scans done which showed no evidence of metastasis, colon resection surgery which showed the tumor had spread through to the outside of the colon but no further, and no lymph node involvement. Appears they got it all with the surgery and further testing a couple months later showed there was no evidence of residual circulating tumor DNA, no chemotherapy indicated at this point, just surveillance ( periodic blood tests, scans, colonoscopies as indicated). I have no idea how long that cancer had been smoldering in my colon, but the general consensus is that it was detected and treated at a relatively early stage.

It could have been so much worse. I'm convinced that without the Eliquis, the GI bleeding from the tumor would not have been enough to drop my hemoglobin so significantly so as to pick it up during routine testing/GP visits. The tumor might well have continued to smolder, grow all the way through the colon to neighboring organs, into the lymph nodes and other organs, no one (including me), being the wiser until the symptoms became so severe there was no ignoring them. By then it could have been a stage 3 or 4 cancer and with much diminished chances of long term survival for me.

Not that this always happens. When I spoke to my cardiologist about this, suggesting perhaps the Eliquis-associated bleeding played a role in picking up my cancer at an earlier stage than otherwise might have happened, he stated there were a couple articles out there that quoted statistics of something like 15% of people on blood thinners with GI bleeding have received a new diagnosis of GI cancer. Not that the Eliquis is to blame for the cancer, and it's surely not a "cancer surveillance" device, but their  take home message is for patients on blood thinners with new onset GI bleeding, NOT to ignore these findings, or just attribute the bleeding to Eliquis-related mucosal membrane issues and dismiss the bleeding, but to investigate the bleeding, find the source and go from there. One of those articles is linked below.

LoonyLil, hopefully your positive occult blood result is due to a more benign source, one that can be easily addressed- as I see it, most often this is found to be the case. But it pays to get it checked out, as I found out, not doing so may have the potential for devastating outcomes.

https://www.ahajournals.org/doi/full/10.1161/JAHA.120.016836

 

Marybird

by Gemita - 2022-11-01 16:53:16

Thank you Mary for sharing this with us all.  The outcome could have been so very different without early detection.  I hope your experience will help other members to get that all important colonoscopy if it is indicated.

Your triumph over your cancer has been truly inspiring and I hope you will continue to do well in the future xx

Thanks to all

by Loonylil - 2022-11-02 07:28:40

With so many thanks to all. Reading all your responses helps a lot, I was certainly really shocked when I originally had the letter from the hospital, but I am beginning to put it into perspective now!

Will keep in touch and let you know what happens

love to all ❤️

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