NOACs Perform Worse Than Warfarin in ... - Atrial Fibrillati...
NOACs Perform Worse Than Warfarin in Real-World Study.
Interesting, thank you for posting.
I'm staying on Warfarin until NOAC's have been around for a long time and their superiority proved. This report is exactly what I'm worried about. Mind you there'll probably be another report next week saying NOAC's are better than Warfarin.
Jean
Most reports are pro NOAC and it does seem that cardiologists now prefer them. With statins patients say that they are being pushed because of the profits being made. For some reason NOAC users don't say that. How long before NOACs can have generic versions?
Report today on doctors paid for prescribing.
Hi Jean, yep, I'm with you on this.
Seems to be yet another medical study to confuse and confound and divide.
Warfarin works for me, has done since 2010, every once in a while I forget not just warfarin but all my evening meds, Bovvered ..... naaaah! just get on with life , don't play catch ups, give myself a severe telling off and take my next dose next day. Sometimes my INR gets too high, sometimes too low - have mastered the dark arts of adjusting green veggie intake and using that technique I self adjust my INR score.
No worries. 
John
Hi
I am on Coumadin and Wanted to know your rule of thumb for adjusting green veggie intake
Salvatore
I take 8mg p.d. if I don't have green veg (e.g. broccoli, spinach) and 9mg if I do.
I never restricted my diet while taking it leaving it to the dosage to let me eat my usual veg. Report yesterday that broccoli is the best vegetable and you never need eat any other. That suits me
Well, the thing with me is I don't really like green veggies, I eat them because I know they are mostly good for me. I have no ruke of thumb. Without green veggies my INR value will tend to rapidly increase to 3.3 or higher. Then I eat lots of green veggies and stay on them in small amounts for a while. I self test with my Coaguchek device so I can monitor my INR any time, and that's the key to it. When my INR is stable I self test to my INR Clinic schedule which can be every 76 days. When it goes haywire I self test every 14 days. I suppose my rule of thumb is small amounts of green veggies regularly should work. I am talking of cabbage, spinach, Brussel sprouts, broccoli. Occasionally, I have small amounts of all ! But then every so often I just go off them all and in season I eat Broad Beans. Peas , my digestive system just cannot handle. My wife tries to keep me eating greens regularly. So this is probably not much help but the key is to self test with my own device. So far at least I get my test strips on NHS prescription without a problem.
John
I am vegan and can not keep my INR steady. I just don't estimate my total VK every day and it fluctuates. If my INR is 4.0 I skip my warfarin and eat 1lb of frozen spinach and it is 2.8 the next day. I also have a Caguchek and now test every 3 days. It bounces around in the 2s but can go out if I wait 4 days. When it does go out it is not by much and I add or drop 2.5mg or add or drop greens. I take 7.5mg warfarin on heavy green days and 5mg on high starch days. Parsley has 2x the k of spinach so I now keep a bunch frozen just in case. I buy my test strips on e bay so its about $4 a test.
On my old health plan the new drugs were about $1,700 a year where as Warfin and frequent testing is around $500. I also like that I can drop my INR closer to 2.0 if I am doing something that has a higher chance of injury like mountain biking or mogul skiing.
My doc has suggested other meds but when ever I have asked a druggist they all say stick with warfarin. The new study also reinforces it is worth the hassle of all the testing.
On reading the article it is as usual not a black or white situation.
The conclusion I came to is that the Warfarin users in the study were, in the main long term users who were very good at taking dose regularly as directed. Whereas those in the study taking NOACs had not been taking the tablets as long and often failed to take the tablets.
The issue seems to perhaps be more of ‘if you don’t take your medication you are more likely to have problems’.
Not at all surprising is it?
Pete
That is what I read too. pottypete1
Yes that's my reading of the evidence. I take Apixaban with alarms on my phone to remind me and to get the timing right.
The critical point here is people remembering to take their pills. INR results can just as easily be distorted by failure to remember this simple point. I tend to be as high as 85%+ in range . more if one discounts slightly higher numbers but then again I never take much notice of what the computer says as I know me best.
Was it you who recently said about warfarin that missed doses made little difference and that one could take their weeks total dosage all at once?
That's not what happened with me. I took two 9mg doses because I'd forgotten to take the previous day's when I first went on it. I started having weird headaches and contacted the Warfarin clinic, they did a test my INR was through the roof and I had the roasting of my life and was told it was both stupid and dangerous. I haven't done it again since infact I'm pretty good with it now.
No it was JonathanPittsCrick who said that but it sounded a bit extreme to me. But what do I know he is the expert.
Pete
Yes, I remember that exchange with JonathanPittsCrick, and I think I begged to differ. Missing one day does have consequences, but they are rarely serious. Missing two days is highly problematic. Missing three days and I would be monitoring 2-3X daily and possibly asking for the Heparin Bridge until sure I was safely out of the danger zone of a low INR.
not guilty.
I take my warfarin in the evening and on occasion find early the next day I have forgotten - I take it then, and then take my dose for that day a bit later in the evening than usual. I am nearly always in range and test myself every 10 days or so. Illness makes my INR leap so I test more regularly then. Not advocating this, mind you, but it works for me!
Hi bob
Did you say you use the computer regarding your warfarin dosage?
How do u use the computer to adjust dosage? I am very interested
I am on W for 8 months now
Thanks
Salvatore
Not me. the clinic uses a computer program with the INR Star system to set the dose. Sadly it does not make any adjustment for trends which is why I often ignore it other wise one tends to drop out or fly off the margin. For example recently I have been dosed by clinic at 5mg but know that on that dose I will go ABOVE 3 . I therefore take 5mg three days a week and 4,5mg four days a week and stay around 2.7. If I started going down below 2.3 I would increase the number of days I take 5mg . This is something that has taken me 15 years to learn so not an easy thing to understand.
agree with both the above answers- adherence is much more important on NOACs as short half life- and they suggest comparison was with stable long term warfarin users.
However, against that, Ive often wondered if lower bleeding risk of NOACS is a) because warfarin users are above range INR or.
b) NOACS are not as effective!!
My GP says if he needed anti coagulants he would l opt for Apixiban
That’s what I have!!
Interesting - I asked my cardiologist what he'd take if he needed anticoagulants and he said dabigatran (Pradaxa) - so that's what I'm on.
I know I am not great at adherence - I have two alarms set on my phone, my family remind me, but still I sometimes forget. So I don't think NOACS would work for me. However my daughter switched from warfarin to Apixiban and manages very well.
I read some research recently that said NOACS were better than Warfarin in some respects...
Quote from article....
[A new, large, real-world study has provided some reassurance about the consequences of suffering an intracerebral hemorrhage (ICH) while receiving one of the new oral anticoagulant (NOAC) drugs.
"In contrary to what many physicians think, that suffering an ICH while taking warfarin type [OACs] may be safer than with NOACs because of the availability of specific reversal agents, we actually showed the opposite," senior author Gregg Fonarow, MD, from Ronald Reagan University of California, Los Angeles, Medical Center, told Medscape Medical News. "In our study, outcomes were actually better in patients suffering an ICH on NOACs than on warfarin."
Even after adjustment for other baseline differences and comorbidities, there was a 6% absolute reduction in mortality in patients suffering an ICH while receiving a NOAC compared with those receiving warfarin, he said.
"We already know that NOACs are associated with less likelihood of developing an ICH vs warfarin-type agents, but there has been some concern from physicians that if an ICH does happen...outcomes may be worse on NOACs, as patients on warfarin can be given a vitamin K reversal agent to help stop bleeding, but until recently, there hasn't been any specific reversal agents available for these new drugs," he added. "Despite this, there was still a survival benefit in patients suffering an ICH while on a NOAC vs those on warfarin in our real-world study.
"ICH is a devastating adverse effect associated with anticoagulant drugs, with very high mortality rates: one in four of the patients in this study died," Dr Fonarow said. "But our results tell us that if this devastating event does happen, the outcomes are better in those patients taking NOACs than those on warfarin. Our results are an additional reason to potentially favor using a NOAC over warfarin."
The study was published online January 25 in JAMA to coincide with its presentation at International Stroke Conference (ISC) 2018. It has since been published in the February 6 issue of the journal.]
Full article here....
medscape.com/viewarticle/89...
There is so much research out there comparing Warfarin with NOACS taking into account various medical conditions and none, you can read the articles and take your choice....
I am on Warfarin.
2 years ago I severed the artery in my left hand.
In A&E they administered Vitamin K to reverse the anticoagulant effect of the Warfarin whilst they tried for 3 hours with on and off tourniquets to stem the bleeding.
Not quite sure what would have been the situation if I had been on NOACs.
Pete
When i had vit k administered to reverse effects of warfarin in an emergency situation, 12 hours later my INR had only gone from 2.9 to 2.2 . Not exactly instant reversal! X
They would have used the same methods but for longer until the half life reduced effect kicked in I think
Hi Pete in those circumstance whatever anticoagulant you are on you could be in trouble ...
Hopefully packing the wound and a transfusion should keep someone on the 12 hour half life NOACS going .
I always wondered.
Wasn’t a pleasant experience anyway.
Thanks for the reply.
Pete
You were fortunate as it could have been much worse.
Pete,
I'm on Apixaban. Last year my intracostal artery was severed by a retained object from a previous operation - it nearly killed me but the bleeding was managed by the A&E medics at my local hospital. At a Serious Incident Review, I raised the issue of whether being on a NOAC was a contributory problem and was told that they are so used to dealing with bleeds in patients on NOACs that it is not a problem.
I post this just to reassure those people on NOACs.
For a severed artery, I would try first aid with a product called Celox. I carry 2g packets of granules. Then put on top of it an Alginate dressing. Loads on the market, cheap. It stopped a nasty bleed recently in an anticoagulated friend plus held the wound together so no stitching needed. It buys time.
I took warfarin for two years and stuck rigidly to the eating regime (do's and dont's) and my warfarin levels yo yo'd. I was regularly either too low or too high... It was decided that warfarin was not right for me and I changed to a NOAC. I am glad to say it works for me.....
I’m with you Mickey. I was having weekly tests as was balanced less than 50% of the time on Warfarin. I now take Pradaxa and it’s all good so far. Mind you, 75 this year, just hope they won’t start changing it again.
Di
Hi Di,
That is interesting about your experience taking Warfarin. My Mum was taking Warfarin for 15 years or so but suddenly, about 2 years ago her INR levels started going all over the place and she actually became quite ill as her GP was wary of starting her on a NOAC. She had two mini strokes and at that point the decision was taken to try her with a NOAC. There has been an improvement in her health although the two mini strokes have taken their toll. It may be that for some ,ageing may be a factor to be considered if Warfarin is not as compatible, I have been thinking? My Mum is now 88....
Glad you too, are feeling better.
Kind regard
Have been on small dose of Warfarin for three years now 3mg per day. Have had no problems and just have a blood test every 4 to 6 weeks which to me is a good check that your dose is right as I can change. So sticking with Warfarin as it is well proven as it has been used for over 50 years. No doubt the big drug companies will want us a to change just to increase their profit margins from people who need anti coagulant medication.
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