Warfarin and other anti coagulants

[George2467814]

Have been on Warfarin 3.5 daily for about 3 years together with Bisoprolol 2.5. Still have much same symtoms slow stuttering irregular heartbeat...not all the time but quite often. Read recently the new drugs were an improvement on warfarin...but from article not sure if it meant effectiveness as a medication or just more convenient in that you do not require frequent trips to surgery for blood tests. Any thoughts please?

[BobD Volunteer]

Hi George,

Warfarin is not a drug which treats AF. It is an anticoagulant to help prevent a stroke which is five times more likely for people with AF. It works. End of story etc in most cases but some people have trouble keeping in therapeutic range so for them the newer anticoagulants can be a godsend since they do not requite regular testing. It is not a case of effectiveness, merely convenience.

Bisoprolol is not a rhythm control drug, again merely one to control heart rate when in AF so symptoms will continue on this regime.

Read all about anticoagulants from the fact sheets on AF Association main website.

Bob

[George2467814 in reply to BobD]

Thank you BobD. For your clear and helpful reply....most grateful .

[eleanor--1941]

Hello Bob,

I could never get on with Warfin,felt awful all of the time and bleeding too!

Gave it up after a very short time,and was put on to Asprin,took this from the 1990's although I was frequently reminded,this didn't cover me fully for strokes.

From last year I was offered Rivaroxaban and told by my Cardiologist

I had to take it,as getting older,strokes could be most likely,with this,although there is no antidote for another year or so,I started taking this a year past August,no trouble at all.

So if I were you I would give it a go,just take it and don't think about it.

Good luck,let me know how you get on and keep well.

Eleanor.

[eleanor--1941]

Sorry George and Bob,

I sent my reply to Bob in error and not to you George,too early in the morning,just about awake now!!!!

Have a good day and keep well you two.

Eleanor.

[George2467814 in reply to eleanor--1941]

No problem thank you for your reply.

[Halpin]

Some time back I asked for one of these new drugs to replace warfarin. My EP at the time said it would be very hard to get them due to cost, however, my GP prescribed them. I had spent sometime researching these drugs and thought I had covered all avenues. Two problems popped up straight away (a) it had to be taken twice a day and if not taken it leaves the system within a couple of hours. It is very easy to forget to take the second one, get caught in traffic, delayed meetings and or forgetting to take them with you. These are all REAL risk factors. (b) there is no antidote for them, ie if one was unlucky to say have a car accident on a country road, got cut and bleed, the bleeding DOES NOT STOP and if an ambulance turned up they can't stop it either. My reason for changing to this drug was I was moving to live in Portugal where the drivers are basically mad and not like the UK, so I moved back to Warfarin, 50 years tried and tested. James H

[George2467814 in reply to Halpin]

Very valid reason for your decision...we all have to make these choices from time to time and your balanced reasoning for your particular worries seems sensible

[Halpin in reply to George2467814]

The advantage of Warfarin is hospitals can give a shot of Vitamin K.

[PeterWh in reply to Halpin]

Antidote for at least one of the NOACs is available.

In any event as we were told at the AFA patients day in Birmingham in 2015 that in the event of a significant bleed there is no time to administer vitamin k anyway particularily as it has to be picked up from hospital's pharmacy and then on top of that the time for it to work. Also no matter which anticoagulant you are on if you are given blood transfusion then anticoagulant will be diluted and effect decreased.

Also consider some of the NOACs have a lower bleed incidence than warfarin and for quite a few categories of people can be administered as a smaller dose.

You are many many times more likely to die as a result of a result of a road accident than you are to die from a bleed because you are on a NOAC and not on warfarin.

NOACs are particularly good for those whose INR swings.

There is no right and wrong.

[PeterWh in reply to Halpin]

Everyone has to come to their own conclusion. If the lack of an antidote was a real issue then none of the NOACs would have been released for use. One has an antidote now and the others are only months away.

You are incorrect about the fact that the bleeding does not stop. All it means that it takes longer to stop. However that is the IDENTICAL situation with warfarin in the scenario you give. Ambulances do not carry the antidote. In reality if you have a serious bleed measures have to be taken to stop it even if you aren't on any anticoagulants because it won't clot sufficiently.

[Halpin in reply to PeterWh]

Sir, at the time I made my decision my information was correct. What amazed me was that the drug companies were allowed introduce these chemicals into the market place.

[PeterWh in reply to Halpin]

Drug companies are never allowed to introduce medicines or drugs onto the market before getting a whole number of approvals. The approvals are at European level and UK level as NICE. The reviews / assessments have to be by fully qualified medics in that area of specialism(s). Prior to that a number of different levels of clinical trials and assessments have to take place. This is why it often takes over five years to do trials and to get approvals.

If there were only downsides and no upsides again the NOACs would not have been introduced.

Apixaban has to be taken twice a day but other NOACs only once a day like warfarin. It is incorrect to say that it leaves the system within a couple of hours because otherwise you would be unprotected for most of the day and they therefore would have been banned from use!!!!!

Most warfarin users take it in the evening around 18:00 or 19:00 as recommended by Anticoagulation clinics but pressumably you are someone who takes it in the morning so as not to forget, etc.

If you look into it further you will see that there are many, many times more people who die on the roads each year than NOAC users from a bleed.

I repeat that everyone has to come to their own conclusion. Obviously some will make that decision based in whole or in part on emotional aspects and perceived risks rather than real ones and that is not a problem.

When you made your decision that in your mind was the right one for you and so be it. Other people obviously made the completely opposite decision and that was right for them. Neither group can be judged as being right or wrong. There is almost nothing in life that truly has zero risks.

Obviously now there will more accurate data and information about the usage than at the point of release but the fundamentals won't have changed.

Good luck.

[cherylbyrd]

Alternatives to Warfarin such as Pradaxa or Apixaban are much easier to tolerate than warfarin and have fewer side effects. However , if you are prone to bleeding and slow healing, or you have other heart issues than Afib or other medical conditions that require medicines with lots of potential drug interactions, then warfarin may be your only choice. My husband has fared much better since he swithed from Warfarin to Apixaban about a year ago. Ask your EP lots of questions; if you don't have an EP, you should see one before making a change.

[Halpin]

Peter please, I am not knocking progress in science. If you knew what I do for a living you would understand this. During my research into other drugs available at the time I was looking at changing over, I and purely my fault overlooked the fact that an antodote was not available. These drugs were let into the system I should imagine because of the power of the drug companies and no doubt their promises of sorting out any loose ends like antidotes for instance asa. With respect to NICE, my conversations with them included the responsibilities they have including the leaflets that come with each box of tablets AND the costs of the drugs from the drug companies. One of the people specifically mentioned their primary function was money. Have a good and I think enough said on the matter. J.