Please read article at end of this too ...thank you

[Delle]

medsnews.com/blood-thinners...

[Hidden]

and your question is?

[CDreamer]

A somewhat biased rather than balanced view I fear!

And scaremongering - not helpful.

[Bryonny]

would need to read other research based articles - will not stop taking Rivaroxaban based on that article alone.

[Janshep]

I would rather the small risk in Rivaroxaban that I have now taken for well over a year than to have the risk of a stroke or a heart attack

[Hidden]

I think I would prefer to take advice from the many Cardiologists and professional medics, who give unbiased and factual talks at our support group meetings and of course, Dr Sanjay Gupta who tells it as it is, in words we can all understand so that we can make our own informed decisions about what is right for us........

[cassie46]

I have been on Rivaroxaban for four years and will not be changing. There have been quite a few of these articles since I started it - most are scare mongering followed by a lot of ambulance chaser taking out law cases for even minor bleeds (USA based of course). There is a slight risk but I will take that - and for any major surgery I will sort with my medics at the time what is best for me.

Cassie

[Bagrat]

Life is a risky business.

[secondtry]

Thank you for posting. I haven't read it yet but from the other comments, I assume it is anti NOACs. I personally think they are a valuable tool to have in the box but I think we are all being railroaded into something which in many cases could be delayed. Timing is an individual decision incorporating many factors - life is rarely simple!!

[Fastbeat]

First line and throughout article they they say blood thinning ,will it ever stop it does not thin blood.

[doodle68]

Hi Delle I think the majority of people prescribed anticoagulants will have done their own research and will be well aware of the positive and negative aspects of taking this medication.

When I was faced with a choice of taking anticoagulants, advised to do so or face an increased risk of having a stroke I didn't really feel I had much of an option particularly having seen the results of a stroke when my husband had one in his 40's which lead to his death.

So thank you for the article but I really don't want a reminder of the negative aspects of a medication that I feel I have no choice but to take.

[opal11uk]

I had a stroke when I was 56 caused by PA/F so having taking an anti coagulant ever since, that was nearly 20 years ago and I feel safer in the knowledge that I am on them.

[toonexile]

"Other adverse reactions linked to rivaroxaban...a heightened risk for blood clotting"

Interesting that I was on rivaroxaban (following stroke) for 2 years when I had my second stroke. Switched to apixaban "because it has a better profile (being twice a day rather than once).

I think it's time for further research although I am reasonably happy to be on apixaban.

[fnurd]

Having been ‘Outed’ as a medical statistician on the forum I have been asked to comment on this article. I have looked at the major claims in the article:

The ROCKET AF study.

The article states:

“According to the FDA, however, the trial did not demonstrate that new drug was safer or more effective than its counterpart that was marketed for more than five decades. Rivaroxaban was also associated with many more gastrointestinal bleeding accidents. Among the most threatening side effects of Xarelto, uncontrolled bleeding can be impossible to treat, and neither Bayer nor Janssen Pharmaceutical ever released adequate information on how to stop this kind of problem once it occurs. The numbers of patients who lose their lives in the emergency room keeps rising every day.”

The conclusions of the study state:

“In patients with atrial fibrillation, rivaroxaban was noninferior to warfarin for the

prevention of stroke or systemic embolism. There was no significant between-group

difference in the risk of major bleeding, although intracranial and fatal bleeding

occurred less frequently in the rivaroxaban group.”

So the study never set out to or claimed to show greater efficacy than warfarin. Results actually showed slightly less stroke or systemic embolism for rivaroxaban (1.7% pa versus 2.2%). Major and non-major clinically relevant bleeding rates were similar (14.9% rivaroxaban and 14.5% warfarin). However there were statically significant reductions in intracranial hemorrhage (0.5% vs. 0.7%, P = 0.02), and fatal bleeding (0.2% vs. 0.5%, P = 0.003) in the rivaroxaban group.

Major bleeding from a gastrointestinal site was more common in the rivaroxaban group, (3.2% versus 2.2%, P<0.001).

However Critical bleeding (0.8 versus 1.9% p=0.007), Fatal bleeding (0.4% versus 0.8% p=0.0030 and Intracranial hemorrhage (0.8% versus 1.2% p=0.02) were all reduced in the rivaroxaban group.

So the correct conclusions from the study are that Rivaroxaban is either as good as or better efficacy than warfarin, and although produces more gastrointestinal bleeding has less Critical bleeding, Fatal bleeding and Intracranial hemorrhage.

Bone and Joint Surgery study

The article states:

“A research published in the Journal of Bone and Joint Surgery showed that among 13,000 patients treated the NOAC, many of them had to take many antibiotics to fight off serious wound infections. Leakage was also four times more frequent than in subjects treated with heparins, and the chance of reoperation within 30 days was significantly higher.”

I could not access the full publication, so have to make do with the abstract, which states:

“There were significantly fewer wound complications in the low-molecular-weight heparin group (2.81% compared with 3.85%; OR = 0.72, 95% confidence interval [CI] = 0.58 to 0.90; p = 0.005). There were no significant differences between the low-molecular-weight heparin and rivaroxaban groups in the rates of pulmonary embolism (0.55% compared with 0.36%; OR = 1.52, 95% CI = 0.78 to 2.98), major bleeding (OR = 0.73, 95% CI = 0.48 to 1.12), or all-cause mortality (OR = 0.93, 95% CI = 0.46 to 1.89). There were significantly more symptomatic deep venous thromboses in the low-molecular-weight heparin group (0.91% compared with 0.36%; OR = 2.51, 95% CI = 1.31 to 4.84; p = 0.004).”

So there were indeed more wound infections in Rivaroxaban, 2.81% versus 3.85% for low-molecular-weight heparin (LMWH), but their were more DVTs (0.91%versus 0.36%) in the LMWH group. There were also small differences in pulmonary embolism, major bleeding, and mortality, all in favour of Rivaroxaban. Overall Rivaroxaban was more efficaceous, but was associated with more wound infections.

On a personal note I can point out that LMWH (Enoxaparin and other brand names) is administered as extremely painful injections into the stomach, and has to be self-administered after hospital discharge .

My Conclusions

The article is highly selective, biased, non-objective, and misleading.

It is also is extremely badly and unprofessionally written, which is always a warning sign (as with spam emails). Frequent reference to Big Pharma, market sizes and a general sneering tone suggest a political crusade rather than science.

[JaneFinn in reply to fnurd]

Thank you so much for this, fnurd. REALLY appreciate it.

[Luludean]

Good grief I wish I not read this article!!!!!!!!

Without wanting to bury my head in the sand , I think posting articles like this is flagrant scare mongering.. We with AF are all trying too live normally and rise above the fears we have ..

Pathetic though it may be, we need to trust our cardiologists completely. Mine does not take kindly to being questioned about the pills he prescribes ..and I have no one else to turn to.

[fnurd in reply to Luludean]

Luludean,

"Mine does not take kindly to being questioned about the pills he prescribes"

- Well he should do. Usually it is the most insecure who don't like to be questioned.

"What is the difference between God and a cardiologist? - God doesn't think he is a cardiologist" (as told to me by a GP).

All the evidence available to medics regarding treatment is now available online to anyone who can be bothered to look, so we are not on our own.

Over the years I have been recommended to have 7 orthopaedic surgeries (2 hip, 2 hand, 1 shoulder, 2 knee). In each case I have researched extensively online, looked at clinical trial data (the only valid way of assessing treatments), and viewed forums. I decided to undergo the 2 hip and 1 hand surgeries, and in each case have been delighted with the results.

I refused the shoulder, knee and 1 hand surgeries as all had very poor results in clinical trials. Many years down the line these decisions have been shown to be correct also. The first knee surgery would have resulted in me having been crippled for the last 20 years. The surgeon who wanted to carry out the 2nd knee surgery said his surgery had a 90% success rate. The data in all 3 published clinical trials of the surgery said <50% success rate!

I mention these cases just to illustrate how fallible medics can be (like the rest of us). I take the view that we have to take responsibility for our own heath.