I am still weighing up the pro's and con's of Warfarin versus Apixaban as I am not doing so well on Warfarin.
What I do not like about these new drugs is the fact that no test can be done to determine what level of anticoagulation you are at. I know it does not vary as such but as we all react differently to drugs and some like me have mild kidney damage which I understands affects it how do you know you are fully protected or maybe even too high. Has anyone who is taking these new drugs been given any explanation by their GP or EP or have you all just taken it and believed it would be alright. Apart from kidney tests etc., has anyone had any other tests at all. This is my main concern even more than no antidote.
Thank you.
Joyce
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cmjoyce
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I'v been on Rivaroxaban for about 10 months after over a year on Warfarin. I think people, including some doctors, get a little hung up on measurement. The usual measurement of medication is that it does the job. I'm thinking of medications that people take long term e.g. for hypertension, thyroid problems or even AF. None of those need checking/blood testing every few weeks or even days. Then there are others like Warfarin and diabetes treatment that do need very frequent testing. They just work in different ways.
As far as kidney problems ar concerned, some people on Rivaroxaban can safely take a lower dose. I was told two and a half years ago that I only have one kidney (and may have been born like that). However,the higher dose was prescribed for me and I will have another kidney function test shortly. I haven't had any other tests specifically for Rivaroxaban.
Many people have pointed out that it is possibly more worrying to be on Warfarin if you struggle to maintain a stable INR than on an alternative. I can't quite explain the science of why NOACs work differently but I'm certainly not one to rely on blind faith. I personally find constant testing preposterous and not a reassurance. Put it another way: if you had been put on NOACs straight away rather than Warfarin, would you have begged your doctor for Warfarin?
Hello Joyce. I think you may be missing the point that NOACs work in a different way to warfarin. They operate on a different part of the clotting process for which no test is available or could be. I can't explain the chemical differences of the processes but suffice to say that after due diligence even though I am on warfarin and do not intend to change in the forseeable future I am convinced that the NOACs are safe and effective for those people for whom warfarin is not ideal.. The antidote situation is also a bit of a non starter really since the drugs have such a short half life.
I have never had a problem with warfarin and have had SO much out of NHS in terms of treatment for heart and cancer that I am happy to stay with the cheaper option but would have no worry about changing should this ever become necessary.
That's interesting Bob. I've seen you mention your other health problems before but never the opinion that you've had so much out of the NHS that you are happy to stay on the cheaper option. Also I've seen you say that you have no problems caused by Warfarin.
My heart operation and various less serious treatments that I've had over the years may well have exceeded the National Insurance contributions that I've paid - I haven't kept a balance sheet. However, if NICE has put something on the approved list as being value for money, that's good enough for me. If I felt that a medication would suit me better, for whatever reason, cost wouldn't stop me asking. Selfish probably but there are many things that the government spends my tax money on that I don't like.
Doctors are not supposed to use cost as a reason for not prescribing a drug, although we all know that they do.
My point was that I have zero issues with warfarin so why change? I am not about to waste money just out of pique or whim. Should I have a problem I would be happy whatever. This is not about me it is about re-assuring others of the wisdom or otherwise of NOACs.
Good points from Bob here. I think the main point Joyce is your kidney damage- i would be asking clinicians whether, in your particular case, clearance of the drug would be affected- and whether, if necessary, you would be well enough anti-coagualted with the lower dose available for some NOACS.
I have changed to Apixaban but don't have kidney damage.Hope you get good advice.
Hi Joyce. I changed from warfarin to apixaban about six months ago and I am now thoroughly at ease and confident that it's doing its job. Like you, I was satisfyingly reassured by an INR reading in therapeutic range and because I was constantly seeking that reassurance, I was attending for blood tests almost weekly. But if you think about it, those blood tests, perhaps not as frequent as mine, are necessary because warfarin is not consistently effective. Diet and various other factors mean that it is not always protecting you in the way that it should and adjustments are often necessary. That can vary enormously from person to person of course.
So if you could have a drug that does what almost all other tried and tested drugs do - it just works - day in day out, unaffected by other influences, wouldn't that be a far better option?
Initially, I mourned the loss of seeing a newly entered 2.8 staring back at me from my yellow book, but not anymore Statistically, I am better protected now than I ever was with warfarin. I can eat and drink what I want and no more needles! Mrspat is right. With NOACs available, the warfarin regime seems a preposterous one.
One final point - the no antidote thing is rather overstated. If you are bleeding heavily in a hospital, they'll stop it, whatever anticoagulant you are on. If you are bleeding heavily in 'the middle of nowhere', being on warfarin won't save you unless there's a field of broccoli within reaching distance and you're feeling very hungry!
You have a valid point, trials have shown that there is a huge difference in blood concentrations with the NOACs. Ideally there would be blood tests to optimise dosage, however those are not available outside specialist labs.
However it all depends on how successful you are at maintaining INR. Less than 70% TTR (Time in Therapeutic Range - i.e. 2-3) you're best switching to an NOAC, more than 80%, stick with warfarin - it's then more effective than an NOAC in reducing strokes and bleeds.
However in your case with kidney issues, apixaban could be a good choice as it works well with those with mild kidney disease. But this is a specialist subject so you need to take advice on that.
There have been a number of studies showing that the superiority of NOACs or warfarin is highly dependent on the control that can be achieved - i.e. the TTR.
which compares the NOACs but finds that people with stable INRs are best left on warfarin.
However, just to empahsise, warfarin is only superior if good control can be maintained. That means weekly testing with a monitor. If control isn't so good, as the articles make clear, you're better off on one of the NOACs.
Interesting you say Warfarin is more effective than a NOAC at preventing a stroke. My EP told me the exact opposite. I have been on Apixaban since the end of 2014.
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