I have asked my GP recently to consider whether I am suitable for one of the new anticoagulant drugs (NOACs) Dabigatran (Pradaxa) or Rivaroxaban (Xarelto) for my condition venous thromboembolism (VT); as I have a reaction to warfarin. He has informed me that Dabigatran is not currently licensed for VT but Rivaroxaban is and must be prescribed in the community. OK that's the good news.
These new NOACs are generally safer than warfarin but with any new drug there is a need to build confidence. There have been reports of an increased risk of myocardial infarction in patients on dabigtran and reports outside the UK of fatal bleeding but these reports predominantly relate to elderly patients with renal failure for whom the drugs arguably should not have been prescribed.
Here's the problem, NOAC's are more expensive (tablet for tablet than warfarin) - approximate costs warfarin 5mg tablet 10p (plus monitoring costs), dabigtran any tablet £2.52, rivaroxaban any tablet £2.10. Consequently, PCT's maybe reluctant for patients to have NOAC's prescribed because of cost. However, I am informed there are exceptional patients for whom these drugs maybe preferred option are:
1) patients with warfarin resistance - INR <1.3> 20mg daily;
2) patients with warfarin induced skin necrosis;
3) patients with severe adverse reactions to warfarin,
4) Some patients on long term LMWH as NOAC's maybe cheaper and more effective.
NOAC's should not be prescribed in pregnancy simple because they have not been prescribed to pregnant women in clinical trials.
For me, unless my reaction to warfarin gets any worse, then I will continue to self-test and self-dose weekly as I can achieve a target range of 90%, which when compared to monthly or longer monitoring of only 50%!!!!
Get Self-Testing and Self-dosing now and enjoy a better quality of life.
All the information was obtained from Department of Haematology but has been condensed for the blog. Full copy can be obtained by emailing me firstname.lastname@example.org