GP can't prescribe Rivaroxaban?

[ange1960]

After my last A&E visit for AF the Cardiologist (after discussion) decided I should be on anticoagulants.  I'd previously been prescribed Asprin during another hospital admission 2 weeks before for AF.  (I since found out that NICE do not recommend Asprin for AF) I requested Rivaroxaban rather than Warafin (I'd done some research before) and the cardiologist agreed that this could and would be the best option.  This was late on a Saturday evening after we'd done the chemical cardioversion (large dose of Flecanaide) to stop the AF), I was exhausted, and if I'd wanted to wait for drugs I would have had to stay in hospital overnight again.  Decided to leave and he wrote on my discharge letter to GP to prescribe the Rivaroxaban.  

GP was unable to do this yesterday as it comes up 'Amber & Red; on her system.  She has now writen to the NOAC Service at the hospital as it has to be prescribed by them directly and I have to wait, (continuing to take asprin) until I get an appointment.

Does anyone else take Rivaroxaban and have you had any problems getting it prescribed?

[ange1960]

The doctor  said it was a cost issue.,  all to do with funding.  GP's (in my health authority area) aren't allowed to start patients on 2nd generation  anti coagulants, only warafin. But if started on them from a hospital/clinic appointment the GP is then allowed to continue to prescribe them.

I had read that the report you put a link in for, but have read others  also, and still believe that if I need to take an anticoagulant that Rivaroxoban is better suited for me than warfarin.  I will keep a look out for further developments.

[teach2learn in reply to ange1960]

Might they have better luck with Eliquis, also a NOAC, but not under lawsuit (yet). It's apixiban. Still expensive, tho.

[cat55]

Hi, sorry to move in on your thread Ange but I belIeve Bigleg has a very valid point. I have very paroxysmal AF by which I mean less than 10 episodes in 14 years and yet there is no other treatment except very potent drugs which can have serious side effects. I appreciate that a stroke is the last thing I want but I have huge problems reconciling myself to having to take Warfarin,or indeed any other anticoagulant for something that doesn't affect my life too much. It seems a shame that there is no alternative. I often toy with the idea of using diet to help instead of Warfarin but lack of research holds me back. I realise I am lucky by AF standards but that makes the anti coagulant dilemma more difficult. 

My best wishes, Kath

[ange1960 in reply to cat55]

Thanks for your reply Kath.  I really would prefer not to take anti coagulants.  But there is a huge family history of early heart attacks, strokes, (my sister died of a brain haemorrage aged 46 years) and that coupled with my health history and the AF have led me to believe that I do need to take anticoagulants.  I looked after my dad after he had a major stroke until he died 2 years later.  He was severly affected by the stroke and I will do all i can to reduce my risk of ending up that way.  

I have bad memories of Dad on warfarin, the constant blood tests, changing of dose accordinly, dietry restrictions and he bleed a lot (but would not use an electric razor!).   The new generation seemed the best choice, but reading online I now don't know which is the best.  

Doctors seemed to think the Rivaroxoban would suit me better.  I work full time, have a busy life and wouldn't need the constant monitoring.  It's so hard to know what to do for the best

[cat55 in reply to ange1960]

Just wanted to say I do take Warfarin because of my fear of having a stroke due to the risk associated with AF, I sincerely wish there was something available that didn't carry the side effects that all the anti coagulants do, as I am sure most of us do. Best wishes Kath

[Hidden]

Cat55, as I understand it the risk of having a stroke, after taking into account your chads score , would be the same whether you are having 10 episodes a year or one episode or indeed in permanent AF 

Sandra

[ange1960 in reply to Hidden]

That was how I understand it too Yatsura.  Once you have AF, the stroke risk is there regardles of frequency (or not) of AF.  

[BobD Volunteer in reply to ange1960]

Stroke risk is not dependent on the number or frequency of AF events as you say. Sandra.

Ange, NICE guidelines are that GPs should support patients who wish to take NOACs as opposed to warfarin and that cost  is not a valid reason not to prescribe. I have no doubt that given time you could successfully challenge your GP's  ruling. You are quite right with your family background to wish to be safe and if proper assessment of your risk has been made then do not be put off.  By anybody.

Bob

[ange1960 in reply to BobD]

My GP would have happily done the prescription yesterday, but her computer system would not allow her too.  She said the guide lines they have are that the initial request/supply has to be done by Cardiologist or NOAC clinic before they can continue with the authorising the prescriptions. Its just slowed everything up because I now have to wait for an appointment with NOAC services before it happens. Hopefully that will not be too long.

[barbara2 in reply to BobD]

"Stroke risk is not dependent on the number or frequency of AF events."  

We often see the above comment, but I have wondered what exactly it means. The below is from thrombosisadviser.com:

Cardioembolic stroke is one of the main complications of AF. It occurs when stagnant blood in the fibrillating atrium forms a thrombus that embolizes to the circulation, blocking arterial blood flow and causing ischaemic injury.

The risk of stroke in patients with AF is dependent on the presence of additional risk factors. These include advancing age – in the Framingham study, the annual risk was 1.5% in those aged 50–59 years and 23.5% in those aged 80–89 years. Several risk assessment scoring systems are available to help clinicians estimate the risk of stroke in patients with AF, and to guide recommendations for antithrombotic therapy.

One simple, well-validated points-based risk assessment tool widely used to assess individual patient risk for stroke is known by the acronym ‘CHADS2’.185

thrombosisadviser.com/en/at...

[PeterWh]

Warfarin was stopped as a rat poison donkeys years ago due to their love of green veg. 

[Hidden]

My GP changed me from warfarin to pradaxa at my request due to fluctuating INR 

[Perrylees]

I haven't had a problem - my GP seems to have all varieties of NOAC available! Does it depend on where in the country you live?  Whatever the reason I'd stick with it - rivaroxaban seems to be the anti coagulant of choice for my hospital /GP and I'm sincerely hope they have done their research!  Certainly it seems to be quite well tolerated by most people.  I've had very little problem with it (so far). I know these drugs are expensive so perhaps that's  a factor ?  I took an unopened box of pradaxa (dabigatran) back to the pharmacy when the GP changed my drugs and was told it had to be destroyed because they can't take drugs back and that it was worth well over £100!

Ruth

[RobertELee]

Prepared by lawyers for lawyers!     Ambulance chasing - common in US and spreading across the globe faster than bleeds from Rivaroxaban.  

[Annekw]

I've been on Apixaban for 13 months now,started on it in Tenerife!

On my return home my GP agreed,no problem!In the next few years when they become Generic,they will be the best thing since sliced bread!

[Hidden]

My GP prescribed Apixaban for me no problem. He also said that taking into account e cost of testing, it was probably not much differentto Warfarin cost-wise !!!

[timince]

Ange

Rivaroxaban is under investigation because of a flaw in it's only trial against warfarin. See:

medicaldaily.com/anticoagul...

I've been on Pradaxa (dabigatran) for over 2 years with NO noticeable side effects. Plus there is an effective antidote if needed.

Tim

[cassie46]

When I was diagnosed with AF in early 2014 the cardio put me on aspirin (he said this was due me having an operation in a few months time but I could then go on warafin.

Had operation and when recovered went to my GP and asked that I have a noac - I did not want to be on Warfarin because my dad had so many problems with it.    There was no hesitation and prescribed Rivaroxaban, my hospital discharge notes said to go on Warafin, so GP took no notice of that have been on them for nearly 2 years with no probs.

I have heard that surgeries are still saying the cost is too much and insist on warafin.   Stay firm and you will get there.

Cassie