Warfarin Alternatives

I'm currently on warfarin but in the very early stages of considering one of the alternatives. My first question arises from the fact that dabigatran is taken twice a day, apixaban twice a day but, as I understand it, rivaroxaban is only once a day? Given that 'once a day' is surely more convenient, why isn't rivaroxaban the anticoagulant of choice? What's the downside.....?

20 Replies

  • Like you I'm considering one of the new anticoagulants.

    My EP has suggested Dabigatran as being the best for me as I may need cardioverting. My GP however says his practice always prescribe Rivaroxaban and that's the one the surgery know more about (I do wonder if it may be the cheapest to prescribe). I would guess the difference between the once and twice a day tablets is the twice a day ones leave your body quicker, hence the need for two tablets over 24hrs. I guess if you had a bleed on Rivaroxaban it would take longer for that drug to leave your body. Just a guess as I said, but will be interested to see what other replies there are to your question.


  • I have been on Dabigatran for 10 months now. I first took it because it was recommended by my EP as he wanted to perform an ablation within 2 weeks and didn't want to wait for me to stabilize on Warfarin, I did I lot reading at the time and I came to the conclusion that the reason for x2 a day is that when it originally was launched there was a high bleed rate, especially in the older population, which led to class actions against the company in US. At this time the dose was much higher which was taken x1 day?? After initial trials it was found that bleed rates reduced on a lower dose taken x2 day. I think it was also found that the half life of the drug is 12 hours, hence you need x2 in 24 hour period.

    Apart from some minor digestive problems which are easily minimised by taking WiTH food and drinking a lot of water as you take, I have had no side affects.

    Jean may be correct about the costs but also I believe Rix needs blood tests for liver function? Apart from the normal annual blood screening, tests I don't have anything.

    My EP certainly thought that Dabigatran preferable.

    Hope that helps.

  • I am on Rivaroxaban, suggested by the cardiologist who did my angiogram. As he said he was too busy to talk! I don't know why but looking at the other comments I can say it is expensive and that I am slim, don't have cholesterol issues and hardly drink at all so maybe he thought there should not be a problem with liver function? Only guessing too! It is certainly very convenient to take, you don't have to be too rigid about times and I have not had any serious bleeding/bruising problems.

    Hope that helps.

  • When first diagnosed I was on dagibatran. This didn't make me feel bad but it did make be bleed, specially my gums. And they bled a lot. I looked like I'd been smacked in the mouth.

    My cardio changed me to Rivaroxaban and have no problems at all. No bleeds or upsets stomachs or anything.

    bye a bit more flatulant but my wife assures me I've always been a bit of a trumper.

  • Hi, I have been taking Rivaoxaban for 18 months with no bad effects that I know of. One a day pill taken with food. I was prescribed it as it was the novel anticoagulant authorised in my locality at this time. Yes it is expensive but I had no problem getting it indeed I asked for it and my EP and GP did not challenge it.


  • Hi Dee -Does taking Rivaoxaban have an effect of your digestive system? I suffer with reflux at night and someone on this site has said that Dabagitran, which I'm about to start taking, can upset the stomach.


  • Forgive me butting in here Jean but I have been told that Dabigatran relies heavily on a normal or high acid content in the gut. I am on Omeprazole, a regularly taken anti-acid medication that, as it says on the tin, reduces acid production in the stomach. Therefore, according to my cardiologist, I'm probably not a good candidate for Dabigatran. The other novel alternatives to warfarin are not similarly affected. I don't know if this might impact on your own digestive issues.

  • That's interesting. Thank you for letting me know. Strange how so many of us who have AF also need to take antacids.

  • Hi Jean

    I have acid reflux which I have had for many years and take lansoprazole and occasionally gaviscon if it gets really troublesome.

    I have not found that Rivaoxaban has made any difference at all to my digestion. It has certainly not made it any worse.



  • Hi Dee - I often gets bouts of acid reflux and have usually been able to control it by raising my bedhead a few inches. However for the last few months this hasn't worked. Many years ago I was tested for H-pylori and was heavily positive. I took several courses of strong antibiotics etc (3 types of pills if I remember rightly) which the doctor prescribed to cure it, but they didn't work. My sister who lives in the states eventually sent me some oregano and garlic oil capsules and hey presto the problem was cured.

    I've ordered some oregano oil capsules and hopefully will get them today.

    The regular acid inhibitor capsules doctors prescribe don't help a great deal. I've tried Lansoprazole, Omeprazole and Ranitidine and the side effects I get from taking them are worse than the acid problem e.g insomnia, chest pain, vivid nightmares, dizziness etc. At the moment I only get the reflux at night and if it wakes me I get up and have a few spoonfulls of natural yogurt and sometimes a banana too.



  • I was on Rivaroxaban for 2 months, no problems, it's expensive so GP may not prescribe and my cardiologist said come off for 48 hours before visiting the dentist.

  • I am now on Apixaban after having taken 300mg Aspirin as prescribed by my GP for two years. I knew that the Aspirin was probably doing me more harm than good so I spent hours researching the new anticoagulants on the Internet trying to decide which, in my opinion would suit me best. I tried to read and understand the medical sites and opted for Apixaban because it's internal bleed rate appeared to be lower and was out of your system quicker. Ok,so it's two tablets a day but so is my dose of Flecanaide - no problem. Breakfast and bed time. My GP was understanding but on cost grounds would not prescribe it and said that I had to go onto Warfarin as that's what they prescribed! No way did I want to be limited by what I could eat and have to have constant blood monitoring. So I sent an e mail to my EP's secretary. Later that day a Registrar phoned me from the hospital in Leicester and agreed that Apixaban should be prescribed and he contacted my GP. Result! I now don't feel so panicky when I have an episode of heart frogs and feel that I am in control of the drugs that I take. I was encouraged not to give up by the wonderful people who take the time to write on this forum - reading the posts every morning makes me feel as though I know one or two personally - Loo was in my thoughts the day of her ablation as she felt like my best friend after following her story and I still look forward to her updates. So, do some research, decide what seems to be the right drug for you and please look at the statistics to make your choice, not just because you have to take two tablets a day instead of one! Good luck

  • Thanks to you all for your informative responses.

  • Hi, Rivaroxaban is a first choice, I refused warfarin and was put on Rivaroxaban by my cardiologist. Much depends on your age and condition, NICE recommend it, your GP should discuss it with you and if you are suitable, go for it. In the long run its more cost effective and saves time for all. Warfarin is cheaper but by the time you add all the elements of a blood test its not. There is no reason why you should not have one of these newer anticoagulants.



  • This is all very interesting. I'm on warfarin at present and will be at least until October which'll be 5 months post ablation. I don't know what my EP will recommend anticoag-wise but if he recommends staying on them, I was hoping that he might ask my GP to change me onto one of the NOAC’s. When I originally started the warfarin, the GP refused to consider any of the others because of the lack of antidote, but loads of you seem to to be on them. I really don't like all the diet restrictions and if I'm completely honest, other than avoiding broccoli, spinach and kale, I eat most other things but then feel terrible guilty!!!

  • My GP actually advised me to go on rivaroxiban rather than warfarin.

    No diet problems and you can have a drink. Less monitering and therefore is more cost affective to NHS in the long run . 24 hours to clear out of your system

  • Thanks greengo. I definitely think my plan will be to change from warfarin if I stay on the anticoags.

  • CDreamer. Interesting what you say about going on Dabigatran for ablation as my EP wants me off Dabigatran and back onto Warfarin for my next ablation. He says statistically the results are better

  • Hi may I comment on a common thread here which is the cost of warfarin versus the NOACs,

    This has been carefully calculated by NICE and it's NOT true that warfarin costs more because of the blood tests.

    They have published several papers on the subject, and the annual cost of warfarin INCLUDING blood tests for a stable patient is c. £242.00 per year rising to c £350.00 for first year and less stable patients. (The drug itself is literally pence per month)

    The cheapest NOAC is £705 per annum and that's drug cost only.

    Of course it can then be argued about effectiveness, and potential savings to the NHS by having less stroke sufferers which is a very expensive cost for the NHS.

    My personal view, is that effectiveness has not been proven in the relatively short term trials, and for me and this is an individual decision of course, I'm probably at least 2 years away from asking about NOACs.

    Be well


  • For acid reflux, you should research apple cider vinegar. It can be purchased in capsule form. Or try taking a tablespoon of the the organic stuff when in reflux and you should notice it will go away almost immediately. This website gives some information.


    When you scroll down below the product description, you will find detailed use information. As always you need to be sure anything you take does not interfere with what you are already taking and this site often mentions interaction cautions.

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