Dabigatrin or other alternatives to Warfarin....which to choose?

[10gingercats]

I have had Warfarin for about 6 years...AF dveloped after a throxine mess up by my then GP.I then had a tiny stroke due to the need(not known at that moment in time) for a hole in the heart closure. This was done quite quickly and I felt like a new woman.Thyroxine had been completely wrong for me but T3 became my salvation.........For practical reasons I would like to get shot of Warfarin and try one of the alternatives....apparantly I am very suitable for this but I am a bit concerned at the lack of development of antidotes for Dabigatrin et al. Does anyone have any ideas /knowledge about this? And it would be a bonus to know if others with a relative non complex heart record like me are taking these alternatives and how they find them.

[BobD Volunteer]

The new oral anticoagulants (NOACs) don't have antidotes agreed . They do however have a very short half life hence the need for sometimes twice a day doses and as such the risk of serious bleed is low. Even in the event of an accident I understand that cell packing transfusions can sort out any problems. Even though I take warfarin as I have no problem with it, I support those who wish to change. For the record it seems from my straw pole that Rivaroxaban is the current drug of choice.

Bob

[Barry24 in reply to BobD]

Good Morning Bob,

Any reasoning behind your selection or is it just the convenience of a once-a-day medication?

Kind Regards

Barry

[BobD Volunteer in reply to Barry24]

No Barry just seems from asking around that it is the one most commonly used in my area.

[Barry24 in reply to BobD]

Dear Bob,

Thanks, nice to know.

Kind Regards

Barry

[10gingercats in reply to BobD]

Well, I took the plunge a few days ago. My doctor was really understanding about it....no squabble about costs...I wanted to try Apixaban and he said fine. It will suit you. So I stopped the Warfarin and when it got to 1.3. which took 4 days of no Warfarin I was off!So far so good. I feel fine and cannot begin to tell how relieved I feel at not taking Warfarin...no more blood tests, eat what I want and so on........Thanks for all the advice I got here.

[Rellim296 in reply to 10gingercats]

Liberation!

[10gingercats in reply to Rellim296]

Thanks Rellim 296.Yes Liberation!I was not too bothered as to the X 2 a day for Apixaban.I had read quite widely by the time I got to see my lovely GP and the major players in the game, of 'which of the 3 to take', came down pretty much on the side of Apixaban.I reckon there will be antidotes for all of them quite soon anyway and since I have stopped my bunggie jumping I am less into dangerous sports than I used to be.

[Rellim296 in reply to 10gingercats]

I can live without bungy jumping.

[Rellim296]

Hi 10gingercats - great name and happy thought!

I've just started taking Rivaroxaban, having struggled with Warfarin. My GP told me it will probably be the first of the NOACs to have an antidote. I don't know if that's why he chose it for me, but I had never felt safe taking Warfarin being (illogically I admit) convinced that it would turn out to be a mistake and probably a fatal one.

Whilst I hated Warfarin, I love Rivaroxaban. One pill and you're covered for the next 24 hours, feeling protected from stroke or fairly so, job done. No asking if something has cranberries in it, no fuss, no bother. Constant anticoagulation, no wandering out of range, free to eat anything without balancing out the spinach and the chick peas.

To be fair, after almost two years on Warfarin, nothing untoward had happened, really, and my fears of bleeding to death had diminished quite a bit. But I am surprised at the sense of protection that I now have. Taking Rivaroxaban feels like I'm doing the right thing and Warfarin felt like poison.

I don't have any real heart issues, just AF and the odd quirk that is not significant.

[10gingercats in reply to Rellim296]

My e mail reply disappeared suddenly before I got to the end so I will be quick this time! Two v. interesting replies,thank you.....Rivaroxaban was my GPs suggested preference so I think I will ask for this in the autumn post hols and I am at home and can deal with the new prog. of meds. in a relaxed situations...Will keep you posted.

[Rellim296 in reply to 10gingercats]

It was a quick and easy swap for me with no problems. I have a blood test in a couple of months.

Incidentally I understand that in England and Wales mountain rescue team members do not carry vitamin K, but if team doctors attend (they are not always available) they might be trained to administer appropriate alternative treatment. This may well be what Bob mentions. Anyway, in remote terrain there is no disadvantage to being on a NOAC.

[rosyG]

I think some favour Rivaroxaban as it's only daily- I switched to Apixaban just before Christmas and am very pleased with it. It has to be taken exactly on time because of short half life.

This link will take you to the Surrey cardiology conference I attended last year and there are lots of talks on AF but look at the one about NOACS- I think it's a good comparison you may find helpful

ashfordstpeters.nhs.uk/rese...

[11ellis]

Good morning.

I am on Apixaban and have no problems at all now.

The first few weeks I was a bit light headed but that could have been statins. Anyway no side effects now.

I asked my GP about an antidote and he said one is now in trials and to stick with Apixaban .

[Annekw]

As Bob says drugs like Apixaban have a short shelf life and this is the first one I was given so I have stuck with it,take mine 8am and 8pm,no problems!

As I also have Rheumatoid Arthritis I have monthly blood tests so I feel very well looked after!

I don't worry about no antidote as yet,if it was

not safe it wouldn't be released for use without the antidote !

[stokenorth]

I have been on Dabigatrin now for 2 years. I have had no problems with it . I have even had surgery while taking it. I like the fact that there is no INR testing.

[Pacific in reply to stokenorth]

I read this link a few months ago: medscape.com Antidote reverses Activity of Rivaroxaban (American College of Cardiologists).

I take Dabigatran.

I did become more mindful; not walking around barefoot, and not rushing around when preparing food; no bad thing, for me anyway!

[gemini52]

I did not get on with Warfarin - did not like it at all. I am on Apixaban now and my consultant said his Father was on it and had no problems. He also said that giving anyone Vit K as an antidote for a major bleed would be like "farting in the wind" (his words not mine). He assured me even on Apixaban there are things they could do to help with a major bleed. Not sure what that would be but I'm willing to take that chance. No side effects at all with Apixaban. Good luck!.x.

[10gingercats in reply to gemini52]

Thanks gemini.... ....and to all of those who are being so helpful.Although we all have our own reactions,or not, to drugs it really helps to get an overall view of what others are trying. I have only looked at Dabigatran and Rivaroxaban.....My INR can sometimes change for absolutely no apparent reason......and then it drops like a stone from 2.5/6 to 1.1or thereabouts.Then I am into a battle with the local INR 'adjudicators' as to how much I will take to improve the INR. They usually want to shoot it up into the sky and I have to battle to keep it down and I have to go back to the surgery nurse after 1 week....as if we do not anything else to do!This can happen 3 or 4 weeks running.

[HastyHeart]

As a new and fearful newcomer to the world of 'proper' anticoagulants in April this year, you all may remember my posts on being taken off the useless aspirin by the GP and put on Rivaroxaban as a temporary emergency measure but "persuaded" to go on Warfarin as the "tried and tested" drug, also "no antidote to the new NOACs" but an unspoken admission that it was all about COST! I knew and the GP knew I could insist on staying on Rivaroxaban but when one is scared of lack of support in a new situation I lacked the courage to go it alone so agreed to the Warfarin. I am OK on it and my INR is within range but I am having blood tests weekly and my arms can get sore and bruised. I have also been guilt-tripped by comments about the difference in costs: £1 a month for Warfarin, £67 a month for Rivaroxaban. As there is already an efficient Anticoagulant Clinic established and attached to my local hospital (Lancaster Infirmary) it was a further pressure to make use of its facilities (but they only deal

[10gingercats in reply to HastyHeart]

Do not stay on Warfarin if you are uncomfortable with it.We all have a personal capitation for drugs as prescribed by our GP and you would be very unlucky indeed,and with massive health probs., if you exceeded your capitation.....Guilt does not come into it.You are entitled to have whichever of the new drugs that suits you best. I too am having weekly tests at the moment with Warfarin but plan soon to go over to one of the new drugs, perhaps Apixaban which is said to be the best of the main 3 on offer.If you have a partner, son, daughter, close friend to go with you for support do take them along.While we keep' supporting' the Warfarin clinics with out need for them they will continue to exist but this in not your problem.My local clinic started to' put the wind up me. when they suspected i wanted to change drugs...Oh, but there is no antidote they said!Unless you are into fast car racing and dangerous sports your chances of needing emergency treat. is remote....and I understand the hospitals can deal with these probs. it is just a bit more tricky than a quick fix of vit. K.....Go for it....and good luck.

[HastyHeart]

Got cut off! .......they only deal with Warfarin people) Local health authority is short of money too! So I am quite envious of those of you who have enthusiastic GPs for the NOACs and who aren't concerned about costs, as I would have appreciated a true choice!

[Rellim296 in reply to HastyHeart]

I said to my GP, when he suggested changing me from warfarin to a NOAC, that I had two concerns. One was the lack of antidote and the other was the cost. He swept both aside. There may be no antidote but there are ways of dealing with bleeding. Don't feel bad about the expense he said. There are hidden costs to warfarin and lots of drugs are much dearer than the NOACs.

I didn't know, Hasty Heart, that Lancaster (my nearest A & E) have an Anticoagulant Clinic. It would be nice if they had a support group like Sheffield have.

[HastyHeart in reply to Rellim296]

I am lucky to live on a bus route and can use my bus pass to get me close to the RLI Outpatients Dept where the Anticoagulant Clinic is held. I have no complaints about their efficiency and the support of my nominated Anticoagulant Nurse who has given me her mobile number to call her anytime I am concerned about taking Warfarin. But as the GP told me, the clinic won't offer support/testing for the NOACs (and by implication neither will most local GPs whilst they have the clinic, and their CCGs are leaning on them to keep the status quo going). So of course the clinic is always busy, and the newer drugs don't get tried out. Hey ho, money and jobs are saved! But I can imagine my halo slipping at some point!

[10gingercats in reply to HastyHeart]

Run fast! towrds what you want for yourself and the halo will fall off by itself

[HastyHeart in reply to 10gingercats]

Loved your reply, 10gingercats! Made me laugh++ as I've always had a halo stuck to my head, not always by choice or deservedly!

[Rellim296 in reply to HastyHeart]

Yes, the thing is, if we all move to NOACs there's no need for testing and no need for support! A doctor told me he thought either we would all be on warfarin in a few years or we'd all be on NOACs.