I am looking to see my GP for discussions on changing from Warfarin.
It would appear that there are four other medication.
Pradaxa (dabigatran),
Xarelto (rivaroxaban),
Eliquis (apixaban), and most recently Savaysa (edoxaban)
Unlike warfarin, the newer drugs are, it says, safer and easier for patients to use.
I wonder if any of you are on any of these and what you feel may be the best replacement to wafarin.
Thanks for your help
Have a look at Dr Gupta's video on the subject.
I have been taking Pradaxa for over 3 years. It does need an acid stomach so it isn't ideal if you need to take antacids. No problems so far and it does have an antidote called Praxbind.
I think I’ve been taking my pradaxa wrong. I take 20mg omeprazole first thing in the morning and then I take the pradaxa. Does this mean it’s not working ??
No I don't think so.
When I was first prescribed Pradaxa I was also given an antacid to take for a month. I didn't feel right - my stomach wasn't so good. I posted on here and CDreamer replied that Pradaxa needed an acid stomach. I Googled it and it confirmed that it needed a low pH. So I ditched the antacid and have had no further problem.
If you have no problem then perhaps your antacid is right for you.
Between us we are an all of them. Like all meds, some will suit you, some may not.
I was prescribed Apixaban nearly five years ago and have had no problems with it at all. My cardiologist prefers it as he said it has the ‘lowest bleed factor’ of the four available then. (That was before Edoxaban became available.)
Annual or bi-annual blood test monitoring of liver/kidney function is necessary.
Hi Norm, it’s almost impossible for us to recommend any medication mainly because we are all different and what works for one is not necessarily going to be suitable for someone else. This is something we talked about at length on our table at Exeter and it was interesting how many are happy staying with warfarin compared with where I come from in Surrey. I can only express the logic I used which prompted me to change to Apixaban almost 3 years ago. I was lucky in that I had been involved in a numbers of talks and discussions about DOAC’s at the Surrey Support Group and I was interested in how many of the speakers said that it was necessary, they would prefer their parents to take a DOAC rather than Warfarin. Their argument was generally based on a marginally improved reduction in the risk of bleeding. The ease of taking the medication, removing the need for INR testing and the removal of “no-go foods” from diet also featured high, particularly as patients age and possibly become less mobile.
Many find it difficult to come to terms with no INR tests saying “how can you be sure it’s doing it’s job”. It may be a leap of faith, but I worked on the assumption that all these professionals can’t be wrong.
Do your research and listen to what others have to say, but you can always try one, and if you are not comfortable, you can always go back to Warfarin, but I bet you don’t! Good luck, and pleased we met Wednesday.....John
I have never taken warfarin; I do take apixaban. It has the advantage that it doesn't need to be taken with food, but it has to be taken twice a day. There are no food restrictions, though you shouldn't take St John's Wort. I was told when it was prescribed for me in hospital about 2 years ago, that this was 'the best' anticoagulant. Stupidly I didn't ask for a proper explanation at the time, but I think it's because it has the least (of the DOACs) risk of a brain bleed.
If you are actually happy taking Warfarin, as many people are, then maybe you should stick with what you know? I would be guided by the advice of your medical team if I were you.
I used to be on Pradaxa. I was switched from Elliquis as I was unable to tolorate it. Elliquis just made me feel weak and rotten. Doc switched me to Pradaxa and I didn’t have one problem with it. I was on 150mg twice per day. I think Elliquis was only once per day, so Pradaxa was a bit less convenient. I was taken off of Pradaxa after a successful ablation in Jan 2017. Never has one day’s problem with it but each individual reacts differently to different meds. No blood tests needed with Pradaxa and there is an antidote should you need it. Good luck!
It all depends how stable you are on warfarin. If you're in the right INR range 70% or more of the time then that's the best anti-coag for you. Less then the DOACs are better.
Hi MarkS
I’m inclined to agree wth you, but I’m struggling to find the evidence to support this. What I have found is that the major studies underpinning the switch to DOACS seemed to be comparing them to patients who’s INR control was relatively poor, with INR in range only 60% of the time. Maybe it might follow that if INR is in range 90% of the time, which is not difficult to achieve, then the results might have been different.
Do you have some links to studies comparing warfarin and DOACs based on much better INR control for the warfarin arm?
nejm.org/doi/full/10.1056/N...
Hi Oyster,
You're right, the trials were based on poor INR control. I think that was to make sure the DOACs appeared better than warfarin. I've collected the results of quite a few trials, here are a few:
NOAC or Warfarin for Atrial Fibrillation: Does Time in Therapeutic Range Matter?
ncbi.nlm.nih.gov/pubmed/263...
Non-vitamin K antagonist oral anticoagulants compared with warfarin at different levels of INR control in atrial fibrillation: A meta-analysis of randomized trials.
ncbi.nlm.nih.gov/pubmed/286...
Well-managed warfarin is superior to NOACs
Direct oral anticoagulants versus warfarin: is new always better than the old?
ncbi.nlm.nih.gov/pubmed/295...
These studies show a break-even point in terms of effectiveness of warfarin -v- NOACs at about 65-70% Time in Therapeutic Range. Get to 80% or better then warfarin is superior.
I have a TTR of about 99% and I find that quite easy. I self test with a Coaguchek once every couple of weeks. I self manage the dose of warfarin (between 8 and 9 mg p.d.). I take a Vit K2 pill every day which helps stabilise the INR. I also eat a very varied diet with lots of greens and no restrictions.
About 25% of people cannot get stable on warfarin. For them, the DOACs are great. But I actually think the majority of people would be better on warfarin. And, as they say at my surgery, it would save the NHS are shed load of money.
Many thanks for that MarkS , I haven’t seen these before.
As I read them, they do not examine whether excellent control of INR reduces systemic embolism compared to DOACs, even though logically one would expect that.
Nor was it clear, unless I have missed something, whether excellent control of INR correlated with reduced bleeding risk compared to DOACs.
With the largely one size fits all approach to DOAC dosing, the suspicion remains that warfarin remains potentially superior to DOACs, but it may just be that credible evidence is still lacking.
Of course it would be a very different situation if assays to measure DOAC effectiveness became more widely available.
I am on warfarin and self-test and adjust if necessary (only happens if I am ill). I stay on warfarin because I am so undisciplined and scatty about taking medication at regular times and missing a dose of warfarin only marginally affects my INR. I should add missing a dose it not something I do regularly but it has happened.
My daughter changed from warfarin to Apixaban as she found getting her INR tested at hospital with two small children in tow so inconvenient. She is much happier now but then she is more organised than her mother!
Hi Norm,
I switched to Pradaxa first, and found it caused a bit of stomach upset, and had a little bit of internal bleeding during the course of the meds. Then I "graduated" off of blood thinners for like 2 years - puff, back in afib and back on blood thinners, and went to xarelto with no complaints - then off again for a year, now its 2 years back on xarelto and its fine, though I think I'm "graduating" again post ablation for 8 months, and may be taken off of it again in the near future. Coumadin (warfarin) was something I'd never voluntarily do again.
I was on pradaxa dabigatran for 4.5 months. No problems, no bruising even though I had a big bang on my thigh, no excessive bleeding when I cut my finger when preparing a meal.
However slightly connected: I never had stomach problems but post ablation after a month on it I was given lansoprazole just in case and I never noticed much on that, but owing to some issues I had with tiredness I was given a blood test which was ok but I was low on vit b12 so was put on for a retest in 6 months. I thought " oh no what now" and did some research in this and found that proton pump inhibitors ( your *oprazoles) reduce absorbtion of b12. So putting 2 and 2 together and as I had not had any isseus with acid reflux anuyway I dumped the lansoprasole . My retest was normal!......can't be sure as I have stopped all meds in the Intervening time but b12 reduction is not a known side effect of any of the other drugs.
After being on Warfarin for 3 months I was unable to have a stable INR my GP put me on Rivsroxaban. Within a few hours of taking the first tablet I had pains throughout my body. Either Rivsroxaban was the straw that broke the camel's back with my body showing it didn't want anymore drugs, or it just happened to coincide with the onset of polymyalgia, an auto immune disease. I was taken of Rivaroxaban after 12 days. I had polymyalgiac for nearly 4 years. I went back to Warfarin and bought my own testing meter. Now I stay in range most of the time. My GP offered to prescribe any of the new anticoagulants but it was a case of once bitten, twice shy. Our bodies react to drugs differently and for most Rivaroxaban is fine
I've been on Warfarin for over 6 years, initially I was put on it because I suffered multiple bilateral PEs. When I was rushed into hospital with a heart rate of 200bpm and diagnosed with AF (which they are now saying is possible tachy-brady syndrome after having two 24 hour ECGs) the doctor in resus told me the Warfarin had almost certainly saved me from a stroke. He said in his own personal opinion it was still the best of the bunch when it came to anti coagulants. I must admit for the most part I have been happy (if that's what you can call it) with it and the lady who manages it is fantasic. After nearly meeting my maker early after the clots on my lungs I am happy to have the security of INR tests , it puts my mind at rest!
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