New blood thinners

[Moonriver]

What is the criteria for using the new blood thinners as opposed to warfarin which needs constant checking and diet control? My gp wants me on warfarin not the new one saying you can reverse bleeding with warfarin quickly but not the new ones. I expect the decision is based on cost.

[Hidden]

NICE recommends the new anti-coagulants, but the take-up has been abominably low. In Wales I don't think many people are on it at all but I have no idea if NICE guidelines apply here... I am sure it's to do with cost and also conservatism, doctors preferring the cosy old setup. Ours has a nice warfarin clinic where everyone gets tested on a Thursday and I think it's like a bad habit, very hard to get rid of! Having said that I'm quite happy on warfarin, INR seems to be stable and so far no awful side effects, touch wood!

Lis

[BobD Volunteer]

I think a lot of GPs are worried about the cost implication but they are approved by NICE. By the way PLEASE don't call them blood thinners. They don't! They are anti-coagulants which slow down the clotting process. The viscocity of the blood is unchanged. Some people seem to think that they can make your blood so thin that it starts to leak out but obviously not. If you bleed it is due to a cut or burst blood vessel on in case of stomach, acid erosion.

I used to be very anti these NOACs due to lack of anti-dote but have been convinced by those I trust that they are a valid alternative for those who for what ever reason are unable to maintain a stable INR on warfarin.

Bob

[avenue69]

The new anticoagulants are much more expensive than warfarin, so yes cost is a major factor. However, currently there isn't an antidote to the new blood thinners should you suffer a bleed or require surgery.

The down side to warfarin is that for some it can raise the risk of a bleed. I am one of the unlucky ones and suffered a bleed this year in the subdural area around the brain, two years after being prescribed warfarin in place of aspirin, which I had been taking for the previous ten years.

Your Dr should explain to you your risk rating of both a stroke and a bleed, and not just justify the reason for taking warfarin that there is no antidote for the new anticoagulants.

[shirlygirly]

Im on Rivaroxaban and have no problems whatsoever. I was offered warfarin

initially but as an IBS sufferer I had enough dietry restrictions so was

offered Rivaroxaban. I have cut myself numerous times and had injuries

of various kinds when gardening and dont really notice any significent

bleeding. I do think cost is an issue, mine was prescribed by cardiologist.

This is just from my point of view.

[GolfMyrtleBeach]

I am on Rivarxaban also, following a warfarin related /post ablation stroke. Cost is definitely an issue here in the US of A. Special dispensation is required from most prescription drug plans usually requiring an MD's justification. When approved , our copay is at the highest level, but for me personally, the extra costs are balanced by the work time saved in not having to go for continual monitoring. Also - great to have no dietary restriction and be able to eat all the Brussels sprouts I want...lol

[Beancounter Volunteer]

Hi Moonriver,

Well cost is certainly a factor, but I suspect your GP might not be fully up to date with current thinking.

I am told, that actually the Vitamin K injections, (which reverse the effects of warfarin) take 12 hours to work, so far from "quick reversal" that might be the same length as time as the newer anti-coagulants which due to their short "half life" come out of the body quicker.

I am still on warfarin, but like Bob coming round fairly rapidly to the NOACS, as I think well what's the worst that could happen?

Major trauma such as a car crash, well no difference they would still need to stop any bleeding manually and "tie off" any major bleeds.

Major Bleed?, well yes hospital again, but probably again treated initially with physical intervention, and then given Vit K, but would that work any quicker than simply stopping the NOAC?.

And the NOACs are still relatively new, but there is some evidence that major bleeds are less likely on them, which is swinging them really into focus.

I think as soon as the antidotes currently being tested in the US are approved, then the NOACs are likely to be a much better drug for most of us.

Be well

Ian

[MarkS in reply to Beancounter]

There is actually a far faster way of stopping bleeding with warfarin by using Prothrombin Complex Concentrate. Whereas oral or intravenous injection of Vit K takes 4-6 hours, PCC reverses warfarin immediately. Provided the hospital is told you take warfarin, then in a major accident you should be in no worse case than anyone else who survives getting to the hospital.

See these clinical guidelines for warfarin reversal:

wsh.nhs.uk/AboutUs/FOI/FOIR...

There is no antidote for the NOACs currently so you would just have to wait the 24 hours or so for it to get out of your system.

So it depends on how stable you are on warfarin. If your INR is in range more that 70% of the time, then warfarin is actually more effective than the NOACs. Less than 70% then maybe you should consider switching.

Mark

[Beancounter Volunteer in reply to MarkS]

Thank you Mark

I learn something every day

Ian

[Cammie]

I've just been given riverxoban as a newly diagnosed af sufferer. My N H S hospital has changed many patients over from warfarin and whilst the cost is higher the "hidden savings" being made by the costs cut by not holding warfarin clinics for hundreds each day mean that overall the NHS are saving money. Had no probs with my GP who is also specialist in cardiology as he recommended the new drug. Guess it's all about GP fundholders taking a short term view rather than a holistic one and being up to date with treatment options.

[Hidden]

I was unable to tolerate Warfarin due to the sife effect of severe diarrhoea. Eventually, after 3 months living on immodium to be able to leave the house, the Warfarin nurse agreed to contact my GP for permission to prescribe Dabigatran. I assumed that was due to cost implications.

That was 18 months ago and I have not looked back. My GP monitors progress with blood tests every 6 months now, so no hanging around in Warfarin clinics. I do not have to worry about diet, occasional accidental bleeds have not been a problem, but I was warned to go to A&E if I banged my head as the biggest concern would be for any internal bleeding. As I travel quite a lot, it also means I do not have to worry about inr testing. I had an Ablation 9 months ago and was only off the drug for 48 hours, with no problems. It certainly seems to suit me.

The only slight problem is that the GP will only prescribe one month at a time,due to cost, so it means regular repeat prescriptions and the pharmacies don't seem to keep it in stock, due to cost, so it often means returning to collect. Just inconvenient but worth it because of the benefits. Good luck. Anne