Choosing anticoagulant

[Lindaj754]

Trying to weigh up the pros and cons of apixiban vs warfarin. My GP is recommending the former but it has no reversal which is not encouraging, but the other also seems to have its fair share of horror stories! Where can I get some impartial advice.?

[Hidden]

Hi Linda,

You could try the Anticoagulation UK website, it has shedloads of stuff for you to wander through.

That said, and I am biased, if you go down the Warfarin route then you should also think very seriously about getting the support of your GP, or the support of a local INR Clinic near to you and self test. This will give you all sorts of personal freedoms that would otherwise not be available to you including the ability to travel and/or holiday without fearing what your INR is. I've self tested for years and even take my kit with me on holiday when I go to Australia.

Some people (like me, and I've been on it nearly 10 years now) take to it like a duck to water and others have problems with it and prefer the NOAC's like Apixiban. Personally, I wouldn't move from Warfarin its totally tried and tested in so many respects and over a long, long time. In my case, I've had to come off it and go back on it again twice, once for a scan and the other for knee replacement surgery. No sweat.

Good luck in your decision making.

John

[Lindaj754 in reply to Hidden]

John. Thanks for this. Difficult not to overthink this!

[beardy_chris]

Apixaban is much simpler. No dietary problems - just two tablets a day. The absence of a reversal agent is not a problem. A couple of years ago, I had a problem with a punctured intracostal artery (long story) which was life threatening with or without Apixaban. My local hospital managed it and, afterwards, said it is routine to manage bleeding for patients on DOACS (Direct Oral AntiCoagulants - such as Apixaban) with blood products and is not an issue. A reversal agent is not necessary or required.

[Lindaj754 in reply to beardy_chris]

Thank you . Interesting to hear the reality from the hospital point of view

[jwsonoma]

Hi Linda, My Dr. recommended I stay on Warfarin because I do sports. Better control of coagulation. I can get my INR close to 2.0 vs 2.9. When I have asked pharmacists they have all said it was better to stay on W. because you don't really know much your coagulation has been affected by the other drugs. I have had a couple of good falls while on W. without any serious issues, bruising or bleeding. I saw a photo on line of a snow boarder who took a fall while on one of the newer anticoagulants. He was purple from his waist to knee on one side. He said he didn't fall that hard. That kind of scared me. I eat a plant based diet and test my INR every 4 days with my home tester. It is a pain but I feel safer soon W.

[Lindaj754 in reply to jwsonoma]

Thanks for this

[northernsoul1 in reply to jwsonoma]

And a hell of a lot cheaper for the CCG. I understand that the greatest opposition to the new drugs by the NHS is due to their cost and not clinical need.

[northernsoul1]

Was on Warfarin for some years and changed to NOAC over three years ago. Would not go back to the blood test nonsense. I also understand that they are working on reversal agents which will be available at some stage

[Lindaj754 in reply to northernsoul1]

Thanks for this. Good to know that change is always possible

[rothwell]

Started on Warfarin.....hair was falling out......changed to Apixaban and been on it for 3 years...no problems and keeping my hair!

[beardy_chris in reply to rothwell]

My hair continued to fall out but that might have just been my age!

[Tryfan]

Whilst I have not ever used Warfarin, I have been on Apixaban for a couple of years due to Approx AFib. Still being active, Walker, cyclist and naturally clumsy I was concerned about accidents. Two years on. No discernible side effects and no issues with cuts bruising. Just carry the card that comes with the tablets to inform any medics should you unfortunately involved in an accident.

As a footnote I am less clumsy and take more care than I used to. Could call it a win win.

[Lindaj754 in reply to Tryfan]

Thank you. Thinking initially walking around on eggshells!! Lol

[Barb1]

The DOACs have a much shorter active life than warfarin, therefore come out of your system quicker. I am not worried about a reversal agent as I was told that there are other ways to encourage your blood to clot. Although Vitamin K works with warfarin, it is rarely used. I had a bad bleed with warfarin and they just monitored me in hospital for 4 days whilst it left my system. Then I had a few weeks of getting my INR under control and therefore being under anticoagulated and at risk of a stroke. I am much happier being on a DOAC now.

[Lindaj754 in reply to Barb1]

Thank you. No reversal just seemed so scary to be honest. Good to hear it can be dealt with

[Tapanac]

Actually apparently there now is a reversal for apixaban.

I recently went in for a foot operation and because I had had a recent fib/tachycardia episode I was told to stay on my apixaban. I said what if I bleed and the surgeon mentioned a name which reversed the apixaban, but I can't remember what he said. Then last week I had another bout of Afib and tachycardia, but when I truthfully said I had had no break with taking my anti-coagulant, they were able to do an emergency cardioversion without taking the time to do the scan behind the heart for blood clots. They said they wouldn't have been able to do that with warfarin.

Apart from anything else, the latest anti-coagulants are so much easier to deal with than warfarin as no weekly or whatever blood tests and trying the keep the levels steady. Also apixban is "supposed" to be the kindest to brain, digestive and stomach system.

Good luck to your husband and best wishes

[Lindaj754 in reply to Tapanac]

Thanks for this

[DueNorth]

Hi. Just for info Dabigatran is a NOAC that is reversible. It is more expensive than others I understand and it's acidic so can cause digestive problems if not taken properly, but is another possible option.

[cali111 in reply to DueNorth]

I am on Apixiban but for my ablation the EP gave me Dabigatron for the first half of the day with a heparin bridge as my Chad's was so high and he didnot want me without cover at all.

[Dodie117]

I was on warfarin for about two years and then changed to apixaban purely for convenience. I self tested and kept pretty tight control on my numbers but was a bit of faffing about. Also found travelling/eating out made easier on apixaban. However both are ok but if you go with warfarin get the self testing kit and ask you GP if they will prescribe the strips as they are fairly expensive. Then you only need to get blood tests done by clinic 3 or 4 times a year.

[Lindaj754 in reply to Dodie117]

Thank you for your help

[Gilli54 in reply to Dodie117]

Yes. I have recently become a self tester. It is much easier to monitor your INR and allow for dietary changes. It’s really easy to learn but you do have to buy the machine. But Roche will provide interest free finance over one or two years. My GP prescribed the test strips and lancets. I have stayed on warfarin, but have found that my hair is affected. 🙁 it is hard to work out the best solution. There seem to be pros and cons. 🤷‍♀️

[canadiananna]

I spent about two years on Warfarin before switching to Apixaban also for convenience. I frankly got tired of looking like a bruised drug addict after the regular weekly then two weekly tests. Self testing was never offered by my Dr.

[Lindaj754 in reply to canadiananna]

Thanks. I completely understand this

[baba]

Information

bnf.nice.org.uk/drug/andexa...

[Lindaj754 in reply to baba]

This is indeed very interesting. I was aware that the FDA in the USA had passed this but not heard that NICE had too.

Do we know if this is in certain specialised / private hospitals only?

Thank you for this helpful info

[MarkS]

Warfarin performs better than the NOACs is you're in range (2-3) more than 70% of the time, which is fairly easy to do with Coaguchek home monitoring.

I have never had an issue with food, I eat a very varied diet with lots of green veg. Warfarin reversal takes about 10 mins with PCC which is carried on most air ambulances. NOAC reversal takes about 24 hours unless the very expensive and not widely held reversal agent is used.

So it depends how involved you want to be with your anticoagulation. I like to be involved and in charge of my anticoagulation rather than vice-versa so I take warfarin. Others just want to take a tablet and forget about it or are unstable on warfarin so NOACs are fine for them.

[Jalia]

I've been on warfarin for 17 years and self test at home. I can see what us going on at any time and feel in control.

I can see that if you're starting on anticoagulation then the DOAC s would be much less faff for you.

[Lindaj754 in reply to Jalia]

Thank you for this

[LPE44]

The half-life for NOAC I take - Eliqus - is 12 hours and completely out of your system in 24. I never took Warfarin and cannot say which I prefer but I do like that I can stop it and then go have any kind of procedure within a day or two. Plus not having to test is a huge help since I move around a lot.

As to side-effects, I don't really know if it's the AC or diltiazem or amiodarone but I am tired all the time and sleep 12 hours a day. However, my new doc reduced my diltiazem to 1/3 of what I was on previously and is talking about taking me off Eliqus since my CHADS score is so low (I'd then go on aspirin). I am seeing a little improvement in energy after only a few days of the lower does of diltaizem but really hoping that reduction/removal of the other meds gives me my life back...

[lms0006]

I trust the old standard Coumadin...have been on it for years!

[barbly1]

In the US, the cost difference between coumadin ($3 per month) and Eliquis/apixaban ($230) cash price is huge, but Medicare covers Eliquis if you are 65 or over. Most insurance plans cover it, too. If you have insurance. Those are the cash prices, quoted, if you walk in without insurance. My Medicare is billed a much higher rate -- I think it was nearly $400 a month for a 30 day supply. I am on Eliquis and like it, feel energetic and well. I have been on it for about 15 months.

[Lindaj754 in reply to barbly1]

Thanks. Very fortunate that in the uk I don’t have to pay.

[cali111]

I have been on Apixiban with no bad effects for three years. Even had a tooth out without stopping it. I had a clot in my heart and Apixban moved it after 2yrs were as warfarin did nothing at all. I have heard in the last year that there is a reversal agent. It is superior to Warfarin. But this is only my experience with it.

[Lindaj754]

Thank you. Yes it appears that there is a reversal

[MazzyB]

I’ve been on warfarin for a few years and never had any issues. Hope you get sorted.

[Lindaj754 in reply to MazzyB]

Thank you.