Advice please!

[Chris1945]

I am very perplexed! A few weeks back my GP indicated he would be happy to change me from warfarin to Apixaban, I didn't immediately act upon it but spoke to him again yesterday and he now says he thinks patients who have been on 'long-term' warfarin...in my case 5 years, that it would be better to stay on the warfarin, he hasn't ruled out prescribing me apixaban but says the decision is all mine. Not sure what to think any more so any advice would be greatly appreciated...thanks! x

[Jalia]

I've been on warfarin for a long time.....poss 16 years ( lost count!) and the response I have had is ' if it ain't broke why fix It ' sort of thing! So I'm happy to stay on it , particularly as I also self test which takes away alot of hassle. I would be quite worried about changing at this stage I have to admit

[doodle68]

Hi Chris it is a personal decison, I have been on Apixaban for 2.5 years with no problems. It is important with NOACS which have quite a short half life that you remember to take them twice a day in the case of Apixaban.

By brother has permanant AF and takes warfarin and has done for about 5 years, he seems to have more problems than I do having to avoid certain foods and when he gets ill like last winter when he had a chest infection he had trouble mentaining a stable INR and was going backwards and forwards having blood tests for weeks.

[Hidden in reply to doodle68]

You have to be very careful about taking certain antibiotics while on Warfarin because the consequences can be life threatening. I had a bleeding episode while taking clarithromycin for an infection. The GP who prescribed it was unaware of the drug interaction. I ended up getting off Warfarin after that episode and did just fine for 6 years until I got another DVT and went on Xarelto. I quit the Xarelto 4 months ago due to cognitive issues and extreme pain in my knees, both of which have resolved. The doctor thinks it is my MTHFR mutation that causes me to have problems with every drug I have taken, whether for clots or BP or anything else for that matter.

[10gingercats]

I had various nuisance problems with Warfarin and changed to Apixaban like a shot when my GP quietly raised it.I had been on Warfarin for c 5 years. I am getting on a bit but have no problems remembering to take it.

[faridaro]

Take a look at the following article and may be it will help you to make the decision:

acpinternist.org/weekly/arc...

[CDreamer in reply to faridaro]

Mmmm... interesting article. It talks about ‘significant’ higher incidence but without reading the original study I would be very hard pressed to calculate the actual individual personal risk.

I have a thing about DOACs versus Wafarin argument which seems to be rarely talked about and is I think gets to the heart of the dilemma:-

Wafarin works on INR - which you test for and can therefor monitor the efficacy. Many people find this reassuring and therefor stick to using Warfarin. Others find the whole INR testing and watching what you eat and eating consistently to maintain your INR levels just too tedious and unworkable, especially if you travel a lot and cannot maintain a consistent diet and therefor go for DOACs - forgetting that they also can have issues which seem to be based around absorption. Rivaroxaban for instance, requires ‘a substantial meal’ = about 500 calories, of which there needs to be some fat for the medication to be digested and absorbed adequately. Don’t take it correctly ie with a meal and it is unlikely to be as efficacious because it won’t be absorbed properly. Dabigatran is digested in the stomach and also taken with food and a full glass of water but can and often does cause acid reflux, especially if you take it with a biscuit etc. I

I have absolutely no medical training but have been an amateur sleuth in the matter of anti-coagulants for some years and it seems to me that because you have no way of knowing just how much of the medication is absorbed or how diligent people are at taking their meds on time and in the prescribed manner - you will always get inconsistencies and the essential term here is:- ‘home administered’ therefore how can you possibly trust that trial because there has not been adequate monitoring to only test the actual differences between the efficacy of the drug? For sure it is a ‘real world’ situation but there is also a responsibility on the patient to take the drug in the prescribed manner in order for it to be efficacious and how did this study account for that?

Both Wafarin and DOACs have their pros and cons and as long as both are taken as per instructed and consistently I believe it is very much a matter of which suits you and your lifestyle.

[Hidden]

I am on apixaban, it causes less bleeds and prevents more strokes than warfarin, plus you have no diet restrictions ! The only reason people are kept on warfarin is because it's cheap!

Andy

[Auriculaire in reply to Hidden]

The linked article suggests that in fact it does not prevent more strokes . This is in contradiction to the clinical trials. One of the problems with the latter is that the warfarin arm only had an in INR range of 65% of the time. Other studies have shown that with self testing and being in the INR range 90% of the time NOACs are not superior to Warfarin either in preventing strokes or bleeds.

[CDreamer in reply to Auriculaire]

I think you put your finger on it - if you stay in optimal range.....and how many people are willing or able to self test?

[Angie06]

My mum was on Warfarin for 9yrs and after several falls, infections and winter cold she ended up having so many INR tests that her veins were giving up and they've now put her on Apixaban. I must say she's never been happier and can't understand why she wasn't on it earlier, she's 90yrs and never forgets to take it, it's just become her morning and evening ritual.

[seasider18 in reply to Angie06]

It should just be a finger tip jab for Warfarin testing.

[Angie06 in reply to seasider18]

The District nurse comes round to take a test tube full and sometimes not enough so they would come back for a second, even taking it from her hand or foot if they couldn't find a vein good enough! Poor mum was often black and blue from all this but so much better now that she has Apixaban even it has only been a month.

[JaneChapple in reply to Angie06]

Hi Angie06

I cant believe the nurse is taking a whole test tube of blood for just INR. Its supposed to be finger prick job as mentioned above. Were they doing it altogether and testing for other things that might be wrong?. If not Id be having serious words with them or the GP surgery. They dont take a full test tube of blood for just INR. I know this as hubby is on Warfarin. He was asked if he wanted to go on NOAC but refused as he prefers to know what that his blood is at the correct level. With a NOAC or DOAC you dont know. I believe GPs are suggesting these newer type of drugs now for cheapness as it saves on INR appointments at the surgery but I can understand why some people find it a hassle especially if they have trouble getting to the surgery.

JaneCx

[Alessa69]

Comparing various relatives / friends who are on Warfarin to those of us on NOACs , we seem to have an easier time of it. Beloved is 83 & I’m approaching 67. NOACs work very well for us. My Bro -in -law was on Warfarin long term, had a fall whilst on holiday ,which involved a serous brain bleed . He was off warfarin long term during recovery, now on NOACs and doing very well, and looks and feels a lot better. I suspect that many are kept on Warfarin due cost issues, don’t be scared of changing to a NOAC if given the option ! Have been on Rivaroxaban for 11 months post EP studies for ablation, so far so good !

[Thomas45]

The great thing about Warfarin is that it's tried and tested. It had been used medically for over 60 years.

I did try one of the newet anticoagulants, but had s Very rare side effect, so after 12 days I went back to Warfarin. It doesn't prevent me from eating anything.

I have my own Coaguchek meter and the test strips and lancets are supplied free by the Arrhythmia nurse.

My doctor offered to prescribe any of the newer anticoagulants, but it was a case of once bitten twice shy

[wilsond]

The cynic in me wonders if it's the higher cost of Apixaban that has changed your GPs mind! There are pros and cons. My GP said he preferred people to be on the NOACs because WITH compliance..in other words taking as recommended,they are generally superior. Warfarin users have to monitor carefully to stay in range as it is a volatile drug. On the other hand,at least you can see that you are protected,whereas the NOACs don't give that visual reassurance. Why not ask GP why he thinks warfarin users should stay on it perhaps? Best wishes

[Pumpkkin33]

Im on apixaban alot better than warfarin no blood tests either

[SJB1234]

I was on warfarin for seven years then last year they changed me to apixaban in February I went in to have ablation but they found I had a clot

at bottom of heart, so ablation cancelled and was put straight back on

Warfarin as Doctor said it does not suit everybody. Now going back for

Ablation next week.

[Barb1 in reply to SJB1234]

I had an ablation postponed due to a clot as well. It was probably caused when I had to stop taking the DOAC in preparation. I was back on warfarin whilst clot dissolved then after ablation put on Edoxaban as my EP said that was best for clot prevention

[mavisrich]

I was on warfarin for many years and last year changed to Edoxaban. I am now in the process of going back on warfarin because the muscles in my legs are getting so weak and think it is the Edoxaban that is causing it. Will see when I have been back on the warfarin for a while if it gets better.

[Barb1]

I have not heard about weak muscles due to taking Edoxaban. Will be interested to hear more Mavis

[siouxbee19]

I was the opposite, I had bleeding problems on DOAC's, landed me back in hospital, but not on Warfarin. Having to test INR gets tiresome sometimes, but only because I live a distance from lab. Self testing is out of the question due to insurance and cost reasons.

But everyone's different, perhaps you could try them and see if they work for you, if not, go back to the Warfarin.

Best of luck with whatever you decide! 😀

[Chris1945 in reply to siouxbee19]

Yes you're absolutely right....x

[Chris1945]

Many, many thanks to everyone who has responded, I really appreciate your help getting through this wretched AF affliction. Thankfully, I don't have it permanently, just every now and then and I'm convinced it's to do with my digestion and vagus nerve issues......but that's another subject altogether!

My main reason for being 'attracted' to Apixaban is the dietary aspect....I'm vegetarian, now veering more and more towards Veganism and unusual though it might be to some, a total lover of green veggies (could eat platefuls of them to a band playing!) but restricted of course when on Warfarin and it's the main reason why for me, Apixaban is an attractive option. I will give it a lot of thought, in the meantime, thanks again......ever onwards!

[MarkS in reply to Chris1945]

I eat quite a lot of green veggies and it doesn't affect my INR on warfarin. The thing is to be consistent with your Vit K intake. I take a daily Vit K2 pill which stabilises my INR, I achieve a 99% time in range.

With NOACs it's not so much that the effect doesn't need to be measured, it's that it can't be measured. There have been various articles saying that NOACs would be a lot more effective if their effect could be measured.

I think it comes down to how much of the time you are in the right INR range on warfarin. More than 70% then it's best to stick with warfarin as it's more effective, less than 60% then change to an NOAC. If you do stick with warfarin then I would certainly get a Coaguchek so you can self test, it's the best thing I've ever bought.

[Thomas45 in reply to Chris1945]

No you are not restricted eating greens when on warfarin. I love chard, peas and other greens high in vitamin K. I cannot remember the last time I ate beef or lamb, years ago. I eat very little chicken and pork. If I lived alone I wouldn't eat meat, but coming from a "waste not, want not" family I tend to eat up leftovers from my godson who lives with me.

If you have a regularly high vitamin K diet, then your Warfarin dose is adjusted to take account of it.