I have to decide between Dabigatran or Warfarin and am concerned that there is no reversal for Dabigatran. Can anyone advise me? Dulcimer

[Dulcimer]

[johncb]

There are for's and against for both:

Dabigatran easy to use, no testing, effective straight away, better results in protecting against stroke. On the down side is the no reversal for Dabigatran. This sounds a bit scary but what you must weigh up is the chance of a very serious accident actually happening and how long since you took your dose. On the other side, if you are on Warfrin, is your level correct? and it also still takes some time to administer the Vit K, plasma and platelettes. So the decision is a little clouded and is a personal one, I went for the Dabigratan because of the convenience and I had all sorts of problems getting the levels of Warfrin correct. There is no right or wrong decision, just what you think suits you better. Not sure if that helps or not. All the best to you

[beano2013]

dear johncb. Had the same dilemma and decided to stick with warfarin mainly because the results on dabigratan were unclear. A number of people found they could not tolerate the side effects, but more importantly there does not appear to be any long term data and what there is places it a higher risk than warfarin. The fact that you cannot rectify matters if you have a bleed is just one factor. I decided, at present, to stay with warfarin, but because I had such an erratic INR and kept having to visit the clinic to have it tested every other week, I bought a machine to test my own INR - Cost £299. all other costs paid for by my G.P., clinic. Took a couple of tries to get used to doing it myself, but would not be without it. Takes seconds at no real inconvenience to myself. Hospital require you to contact them every 6 months with your INR results. All ;the best. Beanoj

[SRMGrandma Volunteer]

Just read the newest results of continuing Re-ly trials in the medical literature.Over the past 4 years the findings with dabigatran are quite excellent. Beanoj is right about some people not tolerating it, mostly with GI upset, but there are other of the new anticoagulants that are once daily and don't have that problem, plus the latest study shows same effect of dabigatran with a lower dose so I suspect that soon the common dose will be 110 mg and not 150. Fewer side effects and same coverage with smaller dose will likely be the standard.

Also, in every trial it does show the warfarin less effective against stroke prevention than dabigatran so for that reason of superior stroke protection alone I am a fan. Plus there is no monitoring and no dietary restrictions. AS for the reversal agent it is not a huge issue because it clears the body so quickly and it is also rapidly being accepted in surgical situations now that it has been out for 4 years. You can do well on either medication. You and your doc have to make this choice. Most of us on this site are happy with the choice we've made. What really counts is that you are being anti coagulated, whichever you choose. Be well.

[MarkS]

The answer is it depends - principally on how well you get on with warfarin. If you can stay most of the time within your INR range, then the evidence is that warfarin is at least as good as dabigatran. There's this research from a real life situation in Denmark which shows comparability in results between new users of dabigatran and warfarin. However interestingly, when compared with longer term users of warfarin, dabigatran came off quite a bit worse. See:

ncbi.nlm.nih.gov/pubmed/236...

Also see this article which says that the Rely trial failed to prove any advantage to dabigatran when INR levels exceeded 65-70%:

elsevier.es/sites/default/f...

as this article says, if you add in self management of warfarin, the results are even better. But to do this you do need to fork out £299 for a monitor (the test strips should be free).

If you don't get on with warfarin then dabigatran is a good alternative, as indeed are the other new anticoagulants.

Mark

[jbrucej]

I've been on Dabigatran for a couple of years now after getting frustrated trying to get the correct dose of rat poison.

It really is a take and forget med. I've had three surgeries and all I needed to do was stop a couple of days before and I didn't have bleeding problems. I've had a heart cath in there too and no problem - but it take awhile to stop the bleeding.

I apparently clot pretty easily though because I stopped taking Plavix while still taking Dabigatran and three weeks later I had a pretty significant TIA (not sure how "T" it was since I still have consequences). I was told by the Emergency doc that they couldn't give me the clot buster because of the Pradaxa. I later talked to my cardio and he said they won't give the clot buster even if I were on Warfarin so there you go.

If you are really worried, you might talk to your doc about your genes and how the might impact your reaction to the med: ncbi.nlm.nih.gov/pubmed/234...

[skary]

Am now on Rivaroxaban as Warfarin upset my IBS.... not pleasant at all ! Have been on new one for 2 months now...no problems and just had kidney function test after a month ...which was ok....no more for 3 months. It's really a personal choice ...Warfarin is tried & tested but was once the new boy on the block; I talked to my cardio and he suggested Rivaroxaban ... it has no reversal agent but it's life in your body is very short. He gave me all the pros & cons and I decided to try it. So far so good,

good luck and live life

Nikki

[Tojo2020]

Praxbind (idarucizumab) is approved for dabigatrin reversal in all 50 states over here But, the reversal is not instantaneous. It takes about four hours. The half life of a dose of dabigatran is anywhere from 12 to 17 hours.

I was on dabigatran/Pradaxa for a year or so then switched to apixaban/Eliquis. Tried warfarin but my apatite for spinach and kale precluded a steady INR with warfarin.