Xarelto or also known as rivaroxaban

[di-london]

Good morning, at the advice of the cardiologist my father started this new medication to replace the warfarin. His INR is now 1.51 instead of 2.5 that used to be with warfarin. The doctor advised that the range with rivaroxaban is different to the warfarin and 1.51 is the perfect norm. Does anyone have experience of rivaroxaban and what the INR range is supposed to be, please? Any feedback appreciated. Many thanks

[CDreamer]

I thought that Rivaroxaban as a DOAC did not require INR readings as they are irrelevant. It works in a completely different way to Wafarin

medscape.com/viewarticle/77...

I have been using DOACS for about 4 years on and off and have never had an INR, it’s one of the great advantages of these meds. But blood tests for liver and kidney functions are advised, mostly every 6-12 months for most people.

[Mrspat in reply to CDreamer]

CDreamer is absolutely correct. It is very worrying that a doctor apparently did not know this. There are still a lot of doctors around who are offering warfarin without telling patients about the alternatives.

[CDreamer in reply to Mrspat]

And even more worrying that they think that DOACS need INR tests.

[Ktomoph_]

Hello di

I have been on rivaroxaban for about 2 years now and have not ever been informed of what my INR is. I do have blood tests, but mainly because of the other medication I am on.

My understanding of warfarin is that it is better to be on an alternative if possible. So, sounds like a positive move to me.

[BobD Volunteer]

These new dugs work on a completely different part of the clotting process and do not require INR testing. The only clot here is your doctor! Annual liver and kidney function tests are a good idea if you take DOACs/NOACs but my practise does these regardless after a certain age..

[Beancounter Volunteer in reply to BobD]

"The only clot here is your doctor! "

Well put Bob exactly, Rivaroxaban does effect INR as does Apixiban, and much less so Dabigitran, but as a measure for effectiveness, PT Testing (Prothrombin time, which is measured by INR) for the Doacs is almost useless.

Be well

Ian

[MtLSteven in reply to Beancounter]

I will not let the comment of the Dr being a clot unchallenged.

GP's are human. They cannot know every thing or get every thing right. Do you?

81% of GP practices are short of GP and nursing staff. Even in the leafy, affluent areas of the country. A GP Partner friend (who lives in the wealthy South East) has been told she may not be paid next year and may have to add her own money. The business (aka the GP practice ) is short of money. The crime: employing Locum GPs and nurses to cover maternity leave, other absences and vacancies to satisfy patient demands and expectations. Locum GP's, Nurses and other staff have been employed and let go because of the rising debt.

Some CCG's do not pay on time, because they are short of money.

Locums are not going to be upto speed due to the transitory nature of their work. GP's are restricted by the CCG's and Pathways, Policies and Protocols as to the drugs they can prescribe. My GP cannot prescribe a particular diuretic due to it being off a Pathway and current practice.

Demands and unrealistic expectations from patients continue to rise. This puts a strain on individuals. Every Mental Health Trust has at least one Doctor as an out of area inpatient.

Patients and the population wanted these groups to exist to break down barriers, to improve communication, build communities, work co-operatively with the NHS and be empowered to take responsibility for their health. I've not read of correspondence or action to MPs or CCG's. Twice in the 20th Century the country went to war to defend our freedoms and way of life. I see no similar mind set or actions to protect our individual health and that of the nation.

[Mrspat in reply to MtLSteven]

I’d take issue with the phrase “wealthy South East” although I bet someone can quote statistics. Also, don’t confuse wealthy with leafy. There are plenty of rural poor who often find it less easy to access services.

[Hidden in reply to MtLSteven]

Surely this was but a lighthearted remark followed by an exclamation mark. Perhaps, in any case, the doctor meant that an INR of 1.51 is the ideal level for starting on a DOAC.

[Meeko]

I'm on rivaroxaban I have blood tests for kidney and liver function every 6 months. Take it with a fatty food like a biscuit for best effect. Oh and find a different doctor asap!

[di-london]

Thank you, all, the responses are all very useful and they make sense. Just out of curiosity though, if INR is not measured for the purposes of xarelto, how does one know or measure the level of blood thickness for the purposes of clotting when using Xarelto? It is worth noting that since switching to Xarelto from Warfarin (although could be purely coincidence) that the afib episodes are now every three days instead of a week-10 days as previously.

[KathFrances in reply to di-london]

There is no measure for the effectiveness of Xarelto and the other NOACs. The companies that produce them say that measurement isn't necessary. Maybe a measure will be developed at some point, but as yet there isn't one.

[cassie46 in reply to di-london]

Switching from Warafin to Rivaroxaban should have no effect on AF epsiodes, it must just be coincidence. I think it might be a good idea to change your GP though, I would have little confidence in him from what he has said.

[LeeLee777]

Not approved for APS yet.