Warfarin or rivaroxaban

Hi I am a pharmacist and run an anticoagulantion service. My view is I would stick to warfarin I am very aware of its problems not only on a professional level but also a personal one as my husband has been on it for over 10 years post Aortic Valve replacing. (The new drugs such as Rivaroxaban can't be used for this as there is not enough confidence they are effective enough to prevent clots, the companies have not published any research into this area). I have come across a lot of problems with people on the new anticoagulants including a number of strokes, so quite a few are being switched back to warfarin - not particularly complicated just takes a few days.

As yet there is no antidote to rivaroxaban available in the NHS although there is talk of one soon (it is undergoing clinical trials at the moment) but soon can be quite a while in NHS terms and relies on any hospital you may end up in stocking it - not guaranteed at all. And certainly not in the next year or so.

Also I have studied the research into these new anticoagulants as I did a discertation on them last year for my Masters and there is a real concern from academics and many physicians about the non follow up of patients on these new drugs, the research was all based on patients who were tested as regularly as those on warfarin. And yet it had been marketed as needing no follow up, which is now being doubted quite strongly.

So basically you have a long established drug with well known issues which you are closely monitored on to ensure that your risk of stroke or bleeding is kept to a

Minimum, but can be easily and very rapidly reversed if serious problems occur or you need emergency surgery for anything. Or a new drug with little history and no testing to see how you as an individual are responding to it. Which can be great as it saves you going to your local clinic to have a finger prick every few weeks to check if you are on the optimal treatment. But in reality isn't the peace of mind you get from knowing it's working worth it.

With so many areas of health we are moving to an indivualised treatment, which we have with warfarin but the new ones are returning to a one size fits all scenario.

Having said that we really need people to be guinea pigs to try out these new drugs so that in the future we have much more information about them. Just so long as you feel fully informed and happy to be one of them.

The drugs companies are spending a vast amount of money promoting the new anticoagulants to health professionals where as, as warfarin is so long established it is well out of patent so there is no money from anyone to promote it.

21 Replies

  • Clare11. Thank you so much. I couldn't agree more with you and, as a patient who has been on Warfarin for the same reason as your husband for over 16 years (15 of which I have self managed my Warfarin with a Coaguchek) I would be very reluctant to change from Warfarin to the Novel Oral Anticoagulants.

    It is great to hear a professional's informed view and I am grateful for it.

  • Clare 11. Thanks for this post.Only last week a senior consultant was expressing the same concerns over the NOA including the fact hat there is no anti dote if a person is bleeding.

    Also how does one gauge the effectiveness of a drug if it cannot be monitored?

    Where is there any peace of mind?

    All in all in my opinion it is just another way of making a vast profit from the misfortunes of others.

  • Me too. X

  • Having just made the switch from Warfarin to Rivaroxabin, I am appreciative of this posting.

    I must admit that I felt I was saying goodbye to an old friend when making the switch, as Warfarin had managed to keep my INR stable for some time, although it did take a while to get there!

    The main reason for my switch was to establish if the significant symptoms I was experiencing were a side affect of warfarin.

    It is looking more likely that I have Pulmonary Hypertension for which I am about to engage in a series of tests to confirm this initial diagnosis, commencing with an Echocardiogram next Wednesday.

    I have now been referred to a Consultant Haematologist so I will explore in great detail the most appropriate type of anticoagulant for my use at my appointment.

    My own GP has her own concerns about the unknown long term affects of Rivaroxaban so plenty for me to think about!

  • Hi Clare,

    I wonder if you could possibly explain the process of switching back from Rivaroxaban to Warfarin?

    In light of my last post, this might be an option for me.

    Many thanks!

  • Hi to switch to warfarin from rivaroxaban, your anticoagulant ion clinic will give you 2 days loading of warfarin usually either 5mg or 10mg daily depending on the protocol they use (and if you've been on warfarin before dependant on your previous dose). You keep taking your rivaroxaban during this time but it has to be taken just after the time you get your INR checked as you need to get the INR checked 24 hours after the last dose of rivaroxaban. Then the clinic will adjust the dose of warfarin as per their protocol according to your INR, until it is >2 then you stop your rivaroxaban. This doesn't usually take long but does mean regular testing for a couple of weeks to get you stabilised.

  • Hi I have been on rivaroxaban since 2012 only due to the lack of phenindione they just couldn't get it and I was allergic to warfarin. I get checked every 6 months by my gp and consultant I get a liver function test and they do find my liver test abnormal at times but they only found gallstones, I don't get as much problems such as eating certain foods, headaches, hair loss in same itching and the weekly or 2 weekly trips to the clinic to get my inr checked.

    I was one of the very first patients switched so I know that we are the real life guinea pigs for the drug, it does scare me that long term use is still unknown and there is no antidote but the freedom it gives is great and the small side effects are liveable. But I did do better on phenindione in my opinion just before changing over I bought my own inr machine and only went to the clinic every 6 months. So it's swings and roundabouts really. (I have to episodes of PE in 1997 and 2009 due to heredity antithrombin def 3)

  • Thank you for this valuable information.

    My question does not directly relate to your post but because you are a pharmacist I wondered if you could please advise as to whether or not drinking Twinings cranberry and raspberry or cranberry and blood orange tea can help to increase the INR?

    I feel very worried because for no apparent reason my INR has dropped from the target range of 3 to 4 to 2.0.I have had to increase the warfarin from 7.5 mgms a day to 10 mgms.

    I have reduced my intake of Vitamin K and am ata loss to know what to do to get back on track.

    Thank you


  • Hi V

    It is frustrating when INR suddenly changes it is usually due to a change in diet, herbal teas or 'medicines' alcohol consumption, change in general or weight but I'm sure you've been through these things. And discounted them, there are times we can't explain why are bodies just change how we metabolise drugs (or foods for that matter). I personally would advise you to be careful with any cranberry containing products unless you can be sure to always take the same amount each day. Which is very hard with a food rather than a medicine as the concentrations can vary dramatically between batches especially I believe with teas. I have had a number of patients who have been destabilised by herbal teas.

    Personally I would recommend just sticking with the increased dose - lots of people are taking 10mg - 15mg daily, probably for some reason your liver is working more efficiently and breaking the warfarin down quicker, so you'd need for warfarin has increased.

  • Thank you for this. My INR this morning is 2.6 so it is rising albeit very slowly.I have a coaguchek machine.

    If only I did not have to take warfarin I may get over this depression.

    Sorry if I sound self pitying but I cannot help it sometimes.

    Clexane exacerbated the peripheral neuropathy burning and spasms.

    I have been told that the dose of 120mgmsa day x 3 was far too high.

    The first injection was fine at the time but the following day the peripheral neuropathy was seriously exacerbated with throbbing of the knees and ankles plus stiffness and swelling of my muscles in my legs.

    The nurse whowas administering the injections of 60 Mgms in each syringe should not have proceeded with the injection .

    The second injection produced an immediate throbbing of the left knee quickly followed by intense burning of both knees,legs and feet with numbness and spasms.

    I feel upset at what has happened.

    I have reported this adverse reaction to the MHRA.

    Kind regards


    Kind regards


  • The results of my Echocardiogram performed this afternoon were normal. However, my hospital is one of 9 specialist Centres in the UK for Pulmonary Hypertension and the Cardiologist advised that even a normal Echocardiogram result is not conclusive. They want to establish why I am still getting all of the symptoms of Pulmonary Hypertension. The top Consultants are holding a Multi Disciplinary Meeting about my case/medical history tomorrow and want to arrange for more accurate and reliable tests, beginning with a right side Catheterisation of the heart and then a VQ scan of the lungs. All very worrying but I am getting the best possible care from the experts in this field. I feel quite poorly at the moment. Shortness of breath, chest pain, palpitations and tired all of the time - no energy at all. Need to get to the bottom of it all.

  • Agree with PBirt, it's so good to see your comments, as a pharmacist, (who are often far more better informed on drugs than doctors) on these new anticoagulants.

    I too was offered the chance to swap from warfarin to one (can't recall its name, began with letter 'P') but didn't like the idea of not having that reassurance of my fortnightly blood test at my pharmacist's, so remain on warfarin 5mg three days, 4mg four days a week, after having a pulmonary embolism a year ago. I come off this 6 days before having a THR Surgery on April 20th but commence clexane injections 3 days before surgery. My understanding is after surgery the injections continue for a short times as well as recommencing warfarin. I'm expected to be in hospital up to 2 weeks max, then to my local hospital to recouperate further. I am hoping that I will continue to be given INR tests there.

  • Hi, I have been on warfarin for 8 months and have lost at least half of my hair. My GP wants me to try the new "P" one you mentioned , but hastened to add that if an emergency happened, head injury, or an operation, with warfarin your blood goes back to no normal clotting very quickly on stopping it, but with the new "p" alternative, it does not. I wonder how your operation went ? and how are you coping with your hair loss.

  • Further to my above comment, I have observed that others, also on warfarin, have experienced hair thinning and itching. I do find the hair loss, dramatic thinning quite distressing.

  • I myself experienced hair thinning in the last year of warfarin, never had seen it so thinning before I started takin warfarin but now im off it one month, gotta see what happens next, I do feel for you

  • Worrying that the INR is not checked on new anticoagulants.

    I would steer clear

  • How do you know if the novel anticoagulants are working if the INR is not being monitored?

  • Exactly my worry

  • Oh Dear

    Could you please read my post.

    Worried about 20 year old son.

    No medical follow up since Jan.

    I have no idea what he is being told about anything.

    I was in the room when the specialist said the new drugs were less risky then the old ones.

    I made my excuses and left after a while, I want to be informed and help him but not nosey so left him to talk to specialist.

  • Very difficult situation.

    Perhaps try again.

  • I was told today that the New Oral anticoagulant drugs are not licensed to treat deep vein thrombosis except in the very early stages when the dvt is first diagnosed also told that the new oral anticoagulants can be used to prevent dvt.

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