NOAC v Wafarin

Did anyone else hear the piece on NOACs v Wafarin on Inside Health on radio 4 today?

Interesting that the EP was all for them, better outcomes, less significant bleeds, less overall cost from fewer and shorter hospital admissions. WHEREAS the GP interviewed was VERY cautious - because they weren't familiar with them and had no education regarding antidotes. This was not a concern for the EP by the way!

73 Replies

  • Yes, I heard that report. When I asked my GP if I could change from warfarin, because keeping my inr stable has been very problematic, I was told it wasn't an option as the other options were not reversible. I got the impression that my GP was genuine in his belief that warfarin was preferable. The gap is there in the GPs knowledge.

  • Agreed!

  • It's so interesting how GP's views vary. My GP was fantastic. She gave me plenty of time to consider both options, Warfarin or Rivaroxaban suggesting that I try Rivaroxaban for a month and then see her again to discuss and note any side effects. She later described Warfarin as a 'dirty drug' as it required such significant monitoring. My cardiologist recommended Rivaroxaban initially. I seem to be ok on it which is good as most of the drugs I was prescribed following my heart attack made me very ill. Not on them any more thank goodness.

  • Yep! I sure did! I am in the bowels of France at the moment and got it on the Internet. Unfortunately, I missed the first part but I gathered that NICE are very much in favour of the new drug as the saving made in administering and maintaining outweighs the extra cost of the medication. I think you are right that GP's are cautious. I will be seeing mine at some point next week and I will ask him. He is very much in touch with new methods, so I will be most interested in what he has to say. I have had some problems with maintaining a steady INR level with Warfarin, possibly because I also have a problem with an old fracture of my ankle which is now ulcerating, speculatively due to a poor blood supply and the nerves are as aggressively painful as anything I have ever experienced. Consequently, I have to periodically take antibiotics and strong (morphine) pain killers until cause and effect are established. Apparently, with this new anticoagulant, the INR would not be affected irrespective of other influences. I can see nothing but good in it. Hey ho!

  • Unfortunately I didn't hear it. When I asked my GP for Apixaban she immediately said ' oh we don't do that here it's too expensive' - exact words. But I was ready for her! I emailed my EP and explained my reasons for preferring Apixaban , he agreed, contacted my GP and that evening she rang to say my prescription for Apixaban was ready to collect. She didn't seem very pleased with me when I went to collect it but it's about me not her budget. One of my main reasons for my decision was that I am a vegetarian and eat a lot if green vegetables - not a good idea if you're on Warfarin. I have not had any side effects from taking it and the twice a day problem people seem to have isn't difficult to overcome. Reassuring to learn that these 'new' alternatives are becoming more popular.

  • Hi Jen , Just felt I had to take up the point you made re eating green veg when on Warfarin. In fact you can eat as much green veg as you like as long as you are consistent in your intake. Eg - eat 500g green veg one day & then none on following 2 days = not a good idea.

    So many people have been ill advised regarding veg intake. As has been said here many times, CONSISTENCY is the key word in foods eaten while on Warfarin.

    Not that this applies to you now but may be of interest to those new to Warfarin.


  • The problem, Yatsura, is that greens vary so much- look at the difference between kale, spinach and then some much lower in Vit K.- One can't eat ka;e and spinach every day so getting the consistent amount is difficult

  • Hi Rosy , sorry for delay in responding. I have been off radar for a few days , celebrating my 70th ( never thought I would reach it at one stage ! ) Yes, I see your point re green veg. Actually I could eat spinach every day but not Kale ( cattle food ) ! I still think that people worry too much about their food intake on Warfarin though.


  • Im glad to hear that you have got your preferred treatment but as I said earlier my GP never once mentioned cost to me when I enquired. he told me that it is because there is no antidote to these like there is for Warfarin. If you have a bad bleed which can still happen it can't be stopped and this was his worry. I trust him completely may I say and a regular visit to have my INR done is a small price to pay for my peace of mind. I hope it is successful for you and look forward to hearing the on going debate about this .

  • As a matter of interest, did you hear the programme?

  • I have heard consultants say the reversal factor is not relevant as the life of the NOACS is so short- apparently warfarin also takes some time to reverse ( not as long but still relevant) If you had a bad head injury with severe bleeding for example you would be in difficulty with with either option.

    Having said that, I like the fact that we can check with warfarin to see if we are sufficienty anti-coagulated.

    If they develop reversal agents and easy tests to see how anti coagulated individual patients are I think we'll be in a different place re decisions.

  • Yes, as a vegetarian myself I was very anxious when told I would have to take an anti-coagulant but my GP was happy, in fact encouraging, of me taking Rivaroxaban instead. I only have to take the drug once a day. You can listen again to the programme on bbc radio iplayer

  • When I mentioned the new anti coagulants to my GP, the student doctor (who was also a pharmacist) who was sitting in on the consultation said that he favoured Warfarin until the alternatives had been around long enough to have been proven to do all that it was claimed they do (he also talked about possible side effects that hadn't come to light yet) - my GP was more non committal, but I got the feeling that he would not have changed my medication unless I was adamant that I wanted him to.

    I think the line taken by the student doctor is a hard one to argue against for a patient with little specialised knowledge - I could have answered that if all doctors had his viewpoint, new medications would not be able to obtain the "authenticity" he talked about, but, unless there is a specific medical argument which makes Warfarin a less preferred option, I think many GPs are reluctant to allow patients to come off it and onto the new medications.

  • I saw my Cardiologist last week, I am in chronic A F and have been for 16 years. He was very much in favour of Rivaroxaban and its benefits and I would have happily changed, But you will have to tick one of the following:

    you have congestive heart failure (when the heart doesn’t pump blood as well as it should)

    you have high blood pressure

    you are 75 or older

    you have diabetes

    you have had a stroke or transient ischaemic attack (mini stroke) in the past.

    Unfortunately I don't tick any box.

    So at the moment I'm still on Warfarin. My Cardiologist has asked for a full heart scan which will happen in a few weeks then I'll see where we go from there.

  • NICE AF guidelines (CG180) now recommend assessment of AF-stroke risk using CHADSVASc, rather than CHADS2. Your cardiologist has assessed you along the CHADS2 assessment:

    C Congestive heart failure (score1)

    H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) (score 1)

    A Age ≥75 years (score 1)

    D Diabetes mellitus (score 1)

    S2 Prior Stroke or TIA or Thromboembolism (score 2)

    If you score more 1 or more on CHADS2, then anticoagulation should be considered.

    CHADSVASc, is an extension of CHADS and is more sensitive to find those at increased risk, and the recommendation is that with a score of 1 or more for men, or 2 or more for female, anticoagulation should be considered:

    C Congestive heart failure (or Left ventricular systolic dysfunction) (score 1)

    H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) (score 1)

    A2 Age ≥75 years(score 2)

    D Diabetes Mellitus (score 1)

    S2 Prior Stroke or TIA or thromboembolism (score 2)

    V Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque) (score 1

    A Age 65–74 years(score 1)

    Sc Sex category (i.e. female sex)(score 1)

    In the past, if you have been recommended to take warfarin, then you should have been assessed to see if you have an increased risk of an AF-stroke, using CHADS, or in more recent times, CHADSVASc. So if you are taking warfarin because of the increased AF-stroke risk, you would also be eligible to consider whether one of the newer anticoagulants would better suit your medical and life style needs.

    Only people diagnosed with AF who score '0' usually do not require anticoagulation, and of course, full medical history and current health needs to be part of the consideration and decision making process.

    I hope this helps!

  • Thank you Jo for that breakdown of the Abreviation of CHADSVASc ...Carol....

  • A voice of reason finally, I score 0 and do not require anticoagulation, however some people on here believe you should be, even with a score of 0 which really is'nt at all logical.

  • Or maybe it fortunately you don't tick any box :-)


  • Hi. They changed me on to Riveroxaban because I had no underlying problems. I am 68. My heart is fine. Working normally except for the A.F. But they couldn't get my stay level .I jumped at the chance and up to now have no regrets.

  • I would not have ticked any of above boxes but got rivaroxaban.

  • Samloaf, new guidance now includes patient choice-

  • The main problem , COST !!!

  • Actually I don't fully agree with you bebe although cost may be a consideration it is not the end of the problem. It has taken us a very long time to get many GPs to consider anticoagulation at all, let alone the NOACs! I went to a meeting some years ago where a leading anticoagulation specialists was talking to GPs and other medics and the general feeling from the room was that warfarin (the only one available then) was to be avoided at all costs. It came out that the GPs had a latent fear of gasto-intestinal bleeds far in excess of any fear of strokes. Subsequent enquiries showed that if a GP had one patient with a GI bleed he was ten times less likely to prescribe warfarin but a patient with a stroke made no difference to his actions.

    Now with that in mind add in the NOACs with no antidote and POW they are going to run a mile metaphorically speaking. Education is making a difference but the older the GP the more of a problem I'm sad to say. I must confess that I held the view of the medical student for some time but while I feel that warfarin is fine for most people who are able to attain a stable INR for those less fortunate then thank goodness for NOACs. Unfortunately the class actions in USA did their cause quite a bit of damage with the bad publicity but give it time.


  • I agree Bob - in the UK NICE have been extremely thorough and comprehensive in looking at safety, effectiveness and cost.

    There is now an ongoing study (Orange study) to look at 'real life' data on bleeding events alongside quality of life and the education / support made available. Any anticoagulant (including warfarin) needs to be prescribed with care and support - but when well managed, the benefits for most are far greater than the risks. 'Individualised patient centred care'..! Assess the risks, discuss the options, risks and benefits, together understand and so agree the therapy!

  • Very well said, thank you Jo.

  • very interesting to read your responses. I have been on warfarin for 3 years now and find it a real pain even though I have my own monitoring machine and self record and medicate. It is fine until I take antibiotics or steroids and then I find I need to check every 3/4 days to ensure inr within parameters. Have been offered new drug, but declined because, to the best of my knowledge, if I had an injury there is no antidote. If anyone has up to date knowledge of any difference in this, I should be grateful to hear it. Beanojones

  • Hi my husband and I both take rivaroxoban and neither of us

    has had any problem, hes taken it for about 5 years Ive taken it

    for around 2 years. We have never been checked but to be

    honest Ive been receiving on going treatment due to having

    ablation, which I had on Monday. I took my last tablet on Saturday

    ablation Monday and back up to the ward with no dressing required

    on groin entry wounds. I was told to take medication immediately

    which I did. Hope this helps.

  • It seems that in the context of less time spent monitoring than warfarin that it is starting to prove more cost affective to the NHS, also in some cases to the patient. I am on rivaroxiban and I am checked every 6 months

  • If you are on Rivaroxiban, please, what do they check?

  • Now you mention it, nothing .

    There is no inr monitoring every week or so like with warfarin

    I do have a blood test every 6 months as I have a very rare blood disorder and this would also show any effect on my liver that rivaroxiban or other drugs I take might have.

    Up to now no problems

    I have also had one ultra sound check on my heart in a period of over a year since my last one.

    I must point out that I have never taken warfarin for my AF as my GP almost insisted from the very start that I should be on rivaroxiban rather than warfarin .

    She is German and might have a different outlook from our British doctors.

    Seeing how warfarin can restrict lifestyles I feel very grateful

    I have had a tooth extracted and an hernia operation and I have had no problems with bleeding

    Best of luck everyone

  • Thank you. Good to hear you've had no problem with bleeding, but could your blood disease contribute to this? I am new to all this, but also on rivaroxiban for AF, so trying to understand all I can.

  • I do not think my blood disease has anything to do with me not (as yet) having any bleeding problems.

    My condition produces too many cells (both red and white). I am told this is very rare.

    All I know is that I have not seen any posts on here which indicate that people on NOACs (rivaroxiban, etc) have had bleeding problems related to them or that they are getting monitored every week. These people are very unlikely to have my condition

    I stand corrected if there has been

    Also NICE, who I believe advise the NHS advocate the use of NOACs rather than warfarin because according to them there would be actually less chance of bleeding incidents compared to warfarin

    My father in law who is on warfarin has continuous bleeding problems from various things such as piles (to put it crudely, I cannot spell the other word) rashes, and minor cuts.

    He is virtually monitored every week and has a low quality of social life such as taking holidays and food and drink etc

    After saying that some people are quite happy on warfarin

    But at the end of the day it is up to the individual to decide which way to go but people should know that they DO have a choice and base their opinion on what they have learned from asking questions such as on this excellent forum.

    The web is a font of knowledge

    Hope that this might help Polski

  • Thank you so much. Your really encourage me. I was concerned about the bleeding aspect, though otherwise very happy not to be on warfarin.

    I usually take supplements, some of which can decrease the speed of clotting, so was unsure about continuing to take them. The doctor said 'fine' but I suspect he is not aware of their possible effects.

    If rivaroxiban has not been a problem to you with respect to bleeding, then I probably don't need to worry too much about the supplements. I try to take them at the other end of the day anyway, when, I understand, the effect of the rivaroxiban has decreased somewhat.

    Thank you, and best wishes.

  • I think that supplements are another matter and that you should really be careful and get expert advice on this and how they might affect anything in conjunction with rivaroxiban

    Take care

  • Thanks CDreamer, just picked it up on BBCiplayer.....very interesting, the debate continues!!

    Best wishes, John

  • no antidote worries me!

  • This is the bit that worries me as well ! and if doctors can't agree how are we supposed to know which is best ? For now i will stay with the tried and tested.

  • funny thing is I have seen a number of specialist and my own GP and not one has even mentioned I try it/them ? Which is strange as I am unstable at the moment for some weird reason?

  • But it is out of your system very quickly. Rivaroxaban has what they call a 'short half life'.

  • 6 hours I think?

  • Note that the half-life of XARELTO® is 5 to 9 hours in healthy subjects aged 20 to 45 years and 11 to 13 hours in the elderly.

    Dosing and Administration - XARELTO

  • I rather like the older person to the elderly :) I have lung and joint issues too and not uncommon to have the odd bleed in the lungs so a 13 hour wait does not suite me. But I can see that it is a great idea for some no more blood tests except to check the kidneys from time to time.

    But that is why I am not so keen some of the points it stated!


    The most common adverse reactions with XARELTO® were bleeding complications.


    Increased Risk of Thrombotic Events After Premature Discontinuation: Premature discontinuation of any oral anticoagulant, including XARELTO®, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events. An increased rate of stroke was observed during the transition from XARELTO® to warfarin in clinical trials in atrial fibrillation patients. If XARELTO® is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.

    Risk of Bleeding: XARELTO® increases the risk of bleeding and can cause serious or fatal bleeding. Promptly evaluate any signs or symptoms of blood loss and consider the need for blood replacement. Discontinue XARELTO® in patients with active pathological hemorrhage.

    A specific antidote for rivaroxaban is not available. Because of high plasma protein binding, rivaroxaban is not expected to be dialyzable.

    Concomitant use of other drugs affecting hemostasis increases the risk of bleeding. These include aspirin, P2Y12 platelet inhibitors, other antithrombotic agents, fibrinolytic therapy, and NSAIDs.

  • "I rather like the older person to the elderly"

    Not my choice of words it was a copy and paste from the website .

  • hi what program and what day so I can D/L off IPlayer

  • Hi I posted a while ago but the reply has disappeared??? In fact several posts on this thread did. Don't think I said anything to upset the apple cart.

    The programme is yesterdays' edition of Inside Health which was on Radio 4. I understand it is on the BBC I player so should be available today & for the next 7 days.

    I thought it a very balanced programme as it gave 2 very different viewpoints, very similar to the ones expressed here but what struck me was the huge difference between EP opinion and knowledge and GP perception.

  • I did actually ask my GP direct about this and he said that the reason they are more cautious is because if you have a significant bleed and you are on Warfarin they can control the bleed and stop it but on the NOACs they can't. ? Still leaves us poor patients up in the airdoesnt it ?

  • My EP has written to my GP asking for me to change to dabigatrin (his choice but it was a toss-up between that and rivaroxaban). Seeming the said GP next Tuesday to see if he will go for it - I'll let you know!

  • I asked my GP last month about NOACs - he said that as I was in range more than 65% of the time on warfarin then NOACs couldn't be considered. When i told him I wasn't happy with 12 week testing, he said it was in the guidelines.

  • Marion that came out in the programme when the GP was interviewed, if you have no problems with Wafarin the GPs favoured staying on it but if there was trouble stabilising INR then the view was to perhaps try them, cautiously. Which I guess is fair enough.

  • He is mistaken! I would ask to see what he is referring to, NICE do not have time recommendations, and if there is local guidance, it should have clinical data to support it that it relevant to you. Personally, I just made more frequent appointments and when asked why, explained my concern and the life style (it was for a family member) and fear of avoidable strokes. It was a very 'positive' conversation, but short of the Dr denying an appointment - which would look dreadful/negligent if there was an event, I carried on making appointments for every two-three weeks.

  • Thanks Jo

    My GP is always saying " it's in the guidelines " - that's why I asked about the NOACS .

    A nurse takes my blood at the surgery and my GP gets the INR level from the hospital the next day, He (not the hospital) decides my next test date which is then written on my notes. The receptionist phones me with the result and makes me an appointment for the next test.

    Once when I had to see the nurse for some other reason (not AF related) I asked if she could do my INR blood test a few days early and she said she wasn't allowed to.

    Slightly off topic - I have been asking him for a cholesterol blood test for over 18 months now since I changed statins - and he still refuses, saying the guidelines say it is not necessary. (Previously I had one every year for 12 years).

    I am happy to continue on warfarin but the long gap between testing concerns me and it makes me over cautious about what I eat and (occasionally) drink.

  • Tell him guidelines are fine but you are the patient and have to live with the consequences.

  • I asked my EP's 2nd in command if I could change to the new anti-coats, but he said not because I was due (possibly) for another ablation or EP Study. I'll be asking him again in a fortnight when I see for my 6-monthly review.

    I do like the sound of them, but also like the comfort of being on a well-tried drug. Surprises down the line with new things are all too common.



  • Only yesterday I was prescribed Rivaroxiban. My GP had no problem at all in prescribing it and confirmed that all GP's would be doing so very soon. I just have to have a blood test to confirm normal kidney function before taking the drug. She did inform me about there being no antidote but I think that this is only given when there has been a major incident not for normal bleeds. Medicine is moving forward all the time and my EP told me that there would very soon be an antidote to the new drugs.

  • Isn't it amazing the difference in perception and attitude between GPs! And there seems to be a consensus amongst EPs but not all cardiologists judging from the responses on this site and other literature I have read.

    I know there will ALWAYS be differing opinions until there is overwhelming evidence that no-one can deny such as happened with smoking.

    Mine had a similar viewpoint and my GP was all for the NOACs, but then he had a special interest and did his research before prescribing.

    I am on a holiday from all AF drugs currently but to be reviewed in 2 years.

    Thanks to all who contributed to the thread.

  • Had TIA few months ago but taking Fruit Flow products and aspirin

    Terrified of Aspirin

    Somebody told me alcohol thins the blood

    Am I a sitting duck ....

  • I don't think it is advisable to mix them. Aspirin is anti-platelet not an anticoagulant. It is not used for AF but it is useful after certain types of Strokes (TIAs) and heart attacks and I believe certain vascular problems. I am not a medic so no training, just what I have learned through my own study.

    I believe you need to talk to your doctor about why you are taking aspirin, if you understand that you may be less anxious. All drugs we take have a risk and a benefit and there is always trade off between the 2. But stopping taking asprin may be riskier.

    The odd glass of something we fancy may do no harm but that is usually much less than we think, half a glass of wine a day is beneficial but 2 glasses would be pushing it, but that is only my personal view.

    Stay well. And I think taking these drugs who wouldn't be scared.

  • I don't think it is advisable to mix them. Aspirin is anti-platelet not an anticoagulant. It is not used for AF but it is useful after certain types of Strokes (TIAs) and heart attacks and I believe certain vascular problems. I am not a medic so no training, just what I have learned through my own study.

    I believe you need to talk to your doctor about why you are taking aspirin, if you understand that you may be less anxious. All drugs we take have a risk and a benefit and there is always trade off between the 2. But stopping taking asprin may be riskier.

    The odd glass of something we fancy may do no harm but that is usually much less than we think, half a glass of wine a day is beneficial but 2 glasses would be pushing it, but that is only my personal view.

    Stay well. And I think taking these drugs who wouldn't be scared.

  • Sorry scared of Warfarin.... Big style.

  • Hi Janeenis

    You have had a TIA, are you an AF sufferer as well?

    If so you must have your CHADS2VASC score checked,

    And if your score is 1 or above, then you must consider proper anti-coagulation such as warfarin.

    There is nothing to be scared about it's a very benign drug easy to take just some pfaffing around with blood tests, but many people on this forum take it daily with almost not real problems. Just 3 simple rules

    No cranberry juice, don't binge on anything, and try not to vary your diet too much.

    Please do NOT allow you doctor to get away with aspirin if you have a a CHADS2VASC score, it's almost useless against the sort of stroke that us AFibbers get.

    Be well


  • Thank you beancounter .... I know I must go on the Warfarin road ... But heard more at risk of brain bleed within first 28 days of taking ??? Now that's scary

    My chads score is 2/3 I think

    What a mess I am

    Know what I need to do but it's a lifetime of drug control ....

  • Hi Janeenis

    Let's be clear there is a risk with any drug, and with warfarin, you are right there is a risk of a bleed, although they are rare, less than 2% I understand and most of those are treatable as warfarin is immediately reversable. But yes some people do die from bleeds.

    BUT lets compare that to the alternative, which is a stroke, and even worse news AF strokes are the very worst kinds of stroke, the kind that either kills you or leaves you drooling in the corner of a nursing home sucking soup through a straw.

    And that stroke risk is a MINIMUM of 5 times normal due to your AF and your CHADS2VASC score tells you you are very much at risk.

    I weighed up that decision several years ago, and my CHADS2VACS score remains at zero. My choice was bleed and perhaps die or perhaps simply be reversed with probably no long term effects, or stroke, and perhaps die, OR sit in a corner drooling with very long term effects.

    In my opinion that was an easy decision, and now warfarin is my very best friend and protector, and yes I will take it for the rest of my life, so what?

    Please come off the aspririn, it's doing nothing for you whatsoever, except increase the risk of a gastro bleed, and go and get anti-coagulated.

    Be well


  • Thankyou Mr Bean... Will see my warfarin nurse next week and take the plunge .....

    Keep you posted ....

  • I procrastinated when I was told I should take warfarin by my cardiologist until the surgery rang me and I really had to comply. Then I refused to take it as I thought it was very scary and was convinced I would have a bleed. In the end my children leaned on me and with huge misgivings I gave in. I was very unhappy about it and felt I was out of step with everyone else. It doesn't seem to have done anything awful and I've been taking it for 16 months now. I'm still not happy as I am on a high dose and struggle to achieve any stability but nothing has gone wrong while I've been taking it and my fears were perhaps unfounded.

    I would rather die from a bleed than have hugely debilitating stroke.

  • I will be forever grateful for all the useful information that I have been offered in the very short time I have been a member of this forum. Having heard the Radio 4 programme, and having had difficulty with maintaining a steady level with Warfarin, I will return to the UK after my autumn sojourn in our Auvergne house, and will pay a visit to my GP and see what he says. Like others, my main worry would be the lack of control with bleeding but maybe that is like never crossing the road because one might get run over. I will

    follow this up with interest, Thank you all!

  • I listened to the programme on catch-up. I was concerned that the consultant, Dr Anders Cohen, was what I considered to be excessively in favour of the NOACs hwhereas the GP seemd to take a more balanced approach. I looked up Dr Cohen's discosures on another site (nothing on the BBC!) and it listed:

    Disclosure: Ander Cohen, MD, has disclosed the following relevant financial relationships:

    Served as an advisor or consultant for: Astellas Pharma, Inc.; AstraZeneca Pharmaceuticals LP; Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc.; GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Mitsubishi Pharma America, Inc.; Pfizer Inc; Portola Pharmaceuticals, Inc.; Sanofi; Schering-Plough Corporation; Takeda Pharmaceuticals North America, Inc.

    Served as a speaker or a member of a speakers bureau for: Astellas Pharma, Inc.; AstraZeneca Pharmaceuticals LP; Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc.; GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Mitsubishi Pharma America, Inc.; Pfizer Inc; Portola Pharmaceuticals, Inc.; Sanofi; Schering-Plough Corporation; Takeda Pharmaceuticals North America, Inc.

    Received grants for clinical research from: Astellas Pharma, Inc.; AstraZeneca Pharmaceuticals LP; Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc.; GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Mitsubishi Pharma America, Inc.; Pfizer Inc; Portola Pharmaceuticals, Inc.; Sanofi; Schering-Plough Corporation; Takeda Pharmaceuticals North America, Inc.

    So he has been paid by the manufacturers of all the NOACs. I think that needs to be taken into consideration in judging what he has to say.

    I think the NOACs are good for those unstable on warfarin, but if you're stable with most of the time in range then you actually have fewer strokes on warfarin.


  • VERY interesting!!!!!!!!!!!!!

  • That could explain a lot! Thank you for researching Dr Cohen.

  • I assume with CHADS and the new vasc version, the fact you've got AF doesn't count. I have always scored zero but my EP put me on Warfarin years ago, and aspirin before that. Over 10 years in all.

    I just don't get it. Apparently the advice is if you have AF you only need AG's if you have a score more than 1 or 2, whatever it is. It just seems you have to wait till you have a problem before you "qualify" for AG's. So if I come off Wrafarin, have a TIA or a stroke, then I qualify to go back on Warfarin !!!

    I don't know whether I should be glad my EP has put me on Warfarin (even though I don't score anything) so I can apparently avoid the stroke that I'm not going to get anyway because my score is zero, or whether I should be worried because I'm taking a drug that I don't need (according to CHADS or vasc) and that could cause a bleed.

    I'm seeing him again in a couple of weeks so this will be the major question as it really bugs me. If the new drugs are less likely to cause a bleed, then I'm going to ask to be put on those instead. And ask why I'm AG'd in the first place.



  • It is very hard to judge what to do isn't it! Especially when medical opinion differs so.

    I was told that coming off AGs was to be thought of as a 'holiday' for 2 years. As soon as I reach 65 I should be back on them again. Evidently that is the 'magic' number when things change and I would need to reconsider.

  • its Interesting getting everyone's thought and opinions. I very rarely discuss my AF with my GP as I see my Cardiologist consultant every 6/12 months and no disrespect to my GP I feel happier that way.

  • I wish I was under the care of a Cardiologist - I was discharged after only one visit. I asked to remain under hospital care but my request was denied.

    I have to rely on my GP who says I must remain on warfarin because my INR is reasonably stable.

    Like you I would feel much happier with 6/12 month Consultant care.

  • Please insist on whats best for you? if you think its best I was on warfrin and in range 60% of time with AF slipped once below range and I am now recovering from a heart attack please insist or change GP its your health

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