I may or may not have a choice between Warfarin and a NOAC when I talk with my Dr this Wednesday, but as always information is essential with decisions. My Warfarin appointment is on Thursday- but as yet I have not had an options discussion with my GP.
As a very recent new patient to AFIB I have been trying to cram in as much information as possible in a short period of time, and maybe getting information overload.
As I understand it the principle downside of a NOAC is the lack of an antidote. And that the drug will remain in your body for around 12 hours. Warfarin does have an antidote- Vitamin K, but that this too takes time to react.
I have a leaning toward a NOAC as they seem to need a lot less monitoring letting me get on with my life a little more, appear more food forgiving and could be travel friendly ( I plan to be in Thailand in late April).
Please forgive me for sharing maybe too much information , but last year I had problems with bleeding Hemorrhoids . This seems to have been fixed by taking Lactulose for the lkast several months. Does anyone consider that this should this be a serious event to make the decision against a NOAC
Thanks again
David
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AgeingHIppy
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I have been taking dabigatran (Pradaxa) for the past 6 months. Apparently there is no great problem because of the current lack of an antidote. You would definitely not be left bleeding to death. I am pleased that it is so fuss-free. The main problem is that it is hugely expensive compared to warfarin and it may therefore be necessary for there to be a good reason for it to be prescribed.
I doubt that this would be a major problem due to the short half life of NOACs. Despite NICE approving these new drugs there is still great reluctance by some GPs and CCGs to prescribe these on cost grounds until warfarin has been tried with poor results. This may be a barrier in your area. As I have been on warfarin for ten years with zero problems I used to wonder why people needed the NOACs but recent studies have changed my thinking and I now support anybody who wishes to go that route PROVIDED that they have understood the differences and risks.
I have been taking Rivaroxaban (20 mg daily) for about nine months. It is easy to take and I take mine at breakfast time with food. As far as I am aware I have no side effects and I do not need any regular testing. I have not noticed any extended bleed times (e.g. when I cut myself shaving) and any bruises clear up normally. Some years ago I had problems with hemorroids but fortunately that is all now behind me.
When compared to what I read about warfarin and its related testing regime I think it would be an easy decision to make. As Bob mentioned, cost is a factor for GP's when deciding what to prescribe.
Hi all, I am bowled over by the responses from everyone- so many thanks to all for the advice and opinions. I am getting a huge amount of comfort from this, maybe I will catch up on my sleep ( Craggy- love your humour I so need a laugh lol ). So shoud be an interesting GP chat .
Thank you all very very appreciated by this newbie
If you are leaning towards NOACS please be aware that the NICE spokesman attending the Surrey cardiac conference I attended recently confirmed we have a legal right to NOACS now unless there is a clinical reason to refuse them. Some CCGs are restricting on cost grounds but they are open to challenge!!
I don't want to to influence you either way but tell you about this as you mention above you are thinking of NOACs seriously.
Some other forum members have mentioned some new research that has found antidotes to NOACS now- I don't know when they will be readily available.
Thank you rosyG all information is appreciated , I have been reading up on antidotes and the makers appear hopeful of 2015, but how long that will take to gain approval I wonder.
I personally don't think that an antidote is a big issue. My EP recommended going straight onto Apixaban last year. The pros and cons were discussed with him and I agreed. I was on Apixaban for 3.5 months and only changed over to Warfarin so that I can have a catheter ablation. Even though my CHADs score was very low they said that INR on Warfarin had to be OK before stopping Apixaban because Apixaban would not be effective for too long after stopping (I think they said circa a day). Started Warfarin on a Monday and INR at 3.1 on the Thursday so Apixaban was stopped. Originally blood test was to be the Wednesday. Hope that helps.
Hi PetrWh, thanks you for sharing. I wish now I had seen an EP, I did not know of their existence until I joined AF. I was referred to another GP whose parctice offered an echocardiogram. I will bring this up with GP on Wednesday.
I am lucky to have a very good GP. My GP's first choice was only for me to see a specialist in AF and not a cardiac consultant (I only learnt later that this is an "EP"). Certainly a couple of consultations with GP went well over the 10 mins allowed (one was 25 mins!!).
hI Greengo1, thank you. I want to contine growing old disgracefully, so you are spot on as normal as possible lifestyle is my goal probably just the same as everyone else.
Rivaraxiban seems to be well supported here, I shall ask on Wednesday. Am taking wife in as additional support- fingers crossed.
I like the idea of minimum fuss if that is possible!
I started on one of the new NOACs "Apixaban" one month ago and so far no problems at all. I have the luck to be under the local consultant haematologist (as well as an EP) and have had long discussions with them about the merits, or otherwise, of taking Apixaban rather than Warfarin. In summary this is what their professional opinion is:
Apixaban has some advantages over Warfarin:
1. It is predictable in the way it works unlike Warfarin and thus:
a) it is taken as the same fixed dose twice every day
b) no regular blood tests are necessary, unlike with Warfarin
2. It has limited reactions with other drugs and no significant interactions with diet and alcohol
HOWEVER, it does have some drawbacks.
1. There is no certain antidote for bleeding unlike with Warafin although antidotes are in development
2. There are no reliable blood tests for it unlike the INR with Warfarin
3. There is less experience with the new drug.
I decided on Apixaban because I didn't want the hassle of going to the clinic for INR testing (I am out of the country for four months a year) and because of (2) under the Apixaban heading.
The worry of course is that Apixaban is a new drug but I am sure that, a few years down the line, and, providing there are no unforeseen problems, the NOAC drugs will be used on a regular basis.
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