Warfarin...new alternatives

[George2467814]

Have read much about probs with warfarin monitoring etc but what are the probs with the new drugs for AF? I am usually ok on warfarin but have monthly checks at surgery....sometimes due to diet or medication changes have had to go more frequently but generally can accept this as the price of the protection warfarin gives me. Comments please

[BobD Volunteer]

If warfarin is no big deal to you and you stay in range like I always do then stay with it but if you have problems with INR then the NOAC's are a valid alternative. OK there are theoretical risks with NOACs as there is no current antidote but very small. Some people actually prefer warfarin as the INR test is reassuring that it is working whereas the NOACs have no test, relying on the fact that they work. End of story as they say. There is no right or wrong answer save the one that is right for you.

Bob

[George2467814 in reply to BobD]

Thank you Bob very clear response which I appreciate...will stick with warfarin as I seem to be regularly within 2-3 INR and so a monthly check no problem and as you say it is reassuring to know it's working

[Hidden]

My EP wants me to stay on Warfarin because the new drugs are new but mainly because of the lack of antidote. He said on Warfarin, should I have an accident, they can give me vitamin K and it should work within 20 minutes. Testing is a nuisance but I like the fact that I get results and am monitored. Testing is easy for me as our surgery is only 3 miles away and I've got a job where I can go any time really.

I have bought a CoagCheck machine to do my own testing but haven't used it yet.

Koll

[George2467814 in reply to Hidden]

My own thoughts too.thank you

[PeterWh in reply to Hidden]

What I would say each person has to make their own decision as to what is right for them and do their own risk assessment that fits in with their life. I am an analytical person and had to do analyses for work. I am not medically trained.

....How many people do you know who have had a really major life threatening bleed?

....If you had a really major bleed then the chances are that you won't survive the time until an ambulance arrives!!! Not being morbid!!!

.....Contrary to popular belief warfarin does not "thin" the blood it is just an anticoagulation drug that means clotting is slower. Therefore regardless as to whether you are on nothing or warfarin or one of the NOACs when you are cut for an operation your blood will flow at the same rate!!! The actual flow rate does vary from person to person.

.....They have many techniques and tools for stopping blood flows.

.....After all for some people even if the INR is at 3.5 they will still do an ablation.

[Jenbo6]

Like most things in life I think it's a decision mostly down to personal choice. As Bob says, if Warfarin suits your lifestyle and everything runs smoothly then why rock the boat. However, I didn't want to be tied down to regular tests and worry if my INR levels weren't stable ( worry and stress are one of my AF triggers). I have taken Apixaban for about a year now with no adverse effects or heavy bleeding even after a tooth extraction. My EP has offered me an ablation but has said I would have to change to Warfarin before the procedure - I presume that is a precaution again a bleed during the ablation just to be on the safe side.

George, I suggest you research the new drugs on the Internet and then make an informed decision. If you think the new drugs are for you then go back to your GP with your facts. A lot of GP's prefer Warfarin on cost grounds but NICE has an answer for that! Good luck.

[George2467814 in reply to Jenbo6]

Thank you for your helpful reply.

[Gaygay45]

I am on Warfarin and have been for three years. I bought a CoaguChek machine for self testing as soon as my INR was steady. I do checks about every 8 weeks now and phone my result to the clinic. I would like to self regulate my dose too but they do not support that. I find self testing easy and very convenient. When I go abroad I take the machine with me and if My diet is very different I can check my INR as and when I like. However it has never been out of range. You need to buy the meter yourself but the lancets and strips are available on prescription. I have discussed the NOACs with my GP and we agreed that until an antidote is available I am better sticking with Warfarin.

[George2467814 in reply to Gaygay45]

As they say it's a personal choice and I shall stick with Warfarin as it seems to work for me and checks no bother at local GP monthly

[Spiritji]

I have been on Pradaxa (dabigatran) for about 5 months and I really like it. It is expensive though. Still I think it is great.....you have to take with a full glass of water as a small group of people have had stomach upset but I have not encountered that or any side effects at all. I like to eat green leafy vegetables and would not want to be on Wayfarin as there seems restrictions on your diet, I have not had any bleeding problems.....I think it is a good drug.....you don't have to get monitored.....I like that part too

[Barry24]

Hi George,

I'm with Bob on this one, great reply.

Regards

Barry

[cicek]

I have been taking Rivoroxaban for about 8 months now and had no problems whatsoever. I chose it because I didn't want all the fuss of monitoring. All up to the individual choice. I think there is a strong belief that they have found an antitdote to Apixaban and Rivoroxaban (think I read it on this forum a while ago).

[Delphetta in reply to cicek]

Same here. No problems with Rivraoxaban other than my initial anxiety about taking the drug, but I don't even think about it now and in some ways that's useful. I know when initially I was on Clopidegrol and asprin I was always covered in bruises which made me feel like an invalid, on Rivaroxaban I'm not constantly reminded of my heart attack and heart condition so I feel better.

[stokenorth]

I have been taking Pradaxa now for two years with no problems. I have even had surgery, but, because the drug is new I had an Epidural with no problems. My surgery was 18 months ago. I would not go back onto Warfarin . It is an expensive drug but my GP was willing to prescribe it.

[FyldeWhite]

I was on Apixaban but got moved to warfarin a month ago in preparation for an ablation, as far as I know this is so they can monitor and control my INR to ensure it stays within a 2-3 range so he won't need to do the camera checks before my ablation.

Personally preferred the Fire and forget of the Apixaban rather than the ongoing trips to the clinic of the warfarin

[PeterWh in reply to FyldeWhite]

I was on Apixaban until start of January when I was switched over to warfarin (took both for 4 days) and then had an ablation on 30 Mar. They still did the TOE test before starting the ablation. Also they changed the range three weeks before hand to 2.5 to 3.5 and that is still the current range a month on. Different consultants and different hospitals have different rules and guidelines.

[PeterWh in reply to PeterWh]

BTW I was one of the 1% who had trouble being stable on Warfarin (could swing from 3.9 to 1.8 from one week to the next) and so they told me I had to cut out all green vegetables and salads, etc. Only just started to be stable almost 4 months on but interestingly since ablation it has been pretty stable.

[George2467814]

Thank you all for your balanced and easy to follow replies I am most grateful....just one point on diet/warfarin I have not be given any details on what foods to restrict or avoid...do you get this from a website?

[MarkS in reply to George2467814]

You can get the vitamin K content of foods from various sites including:

stross.net/AcRx/AcRx/AcRx-1...

The Chichester site (see home page from the above link) has a lot of information on warfarin generally.

The idea is to have a fairly constant intake of Vit K including green leafy vegetables.

I get around that by taking a Vit K2 pill each day which means I can eat what I like with a very stable INR. I had a stack of asparagus last night and a curry and INR still 2.5 when I tested this morning with my Coaguchek. Just don't follow me into the loo this morning!

[PeterWh in reply to George2467814]

the AFA site has two or three very good leaflets on Warfarin.

[George2467814 in reply to PeterWh]

Thank you Peter will look up

[BobD Volunteer in reply to George2467814]

George make your warfarin dose fit you diet not the other way round.

[George2467814 in reply to BobD]

Very good point don't wish to cut out too many foods making my diet unbalanced

[Hidden in reply to George2467814]

I'm not on any diet on Warfarin. I eat anything and everything, but I do not binge for days on end on anything either. As far as I know, and it keeps getting confirmed on here, you do not need to have a special diet at all. As Bob says, you fit your Warfarin dose to what is needed, not the other way round.

The only change I have had is when I went tee-total a couple of years ago. I went from drinking ⅔ bottle of red wine a day to nought. This resulted in an increase of Warfarin from about 7mgs to 7.5mgs / day.

Koll

[Offcut]

I am sure I read somewhere that they are looking at testing for Noacs users to confirm it is the answer to all. I have been on warfarin since 1992 and since a doubling of my Diltiazem Hydrochloride dosage my INR has fell well below my INR Range 2.5-3.5 and I am having the dose increased again and fortnightly tests

My veins are like rino skin now my blood taker tell me

Be Well

[ianwood]

I asked my GP about this and he pointed out that Warfarin is reverseable if you overdose but the newer drugs you have to wait for them to flush out of your system normaly.

[PeterWh in reply to ianwood]

Yes that is true but the half life is actually relatively short - with Apixaban you have to take it twice a day in order to stay in the protected range.

[ianwood]

That sounds quite good but as I seem to suit Warfarin and am stable on it I will as my GP says " stick with the rat poison ".