Aniticoagulants for AF

[toller]

I'd welcome thoughts on both Apixaban and Rivaroxadan?

Currently taking Warfarin but these have been discussed by my cardiologist as other options.

[BobD Volunteer]

Warfarin is a well understood drug for anticoagulation aand has been used for nearly 70 years. You can't say the same about the others. Warfarin is also the only anticoagulant in some cases although for AF the DOACs are OK . My personal view is if it ain't broke don't fix it and I have been taking warfarin for 16 odd years with zero problems and really good stability of INR BUT for some people who have trouble staying in range these newer drugs are ideal. There does seem to be a trend for GPs to try and get patients onto DOACs at present to avoid having them making their nice clean surgeries dirty by going for blood tests but thankfully mine is not one such.

[Munstermum in reply to BobD]

Thanks for the reply, I've been on warfarin for about 6 years and have been reasonably stable. Do have intermittent issues with INR though, some expected when I've been on other medications but sometimes a reason can't be found.

[Hidden]

Hello, lots of people are currently being advised to switch to one of the newer anticoagulant medications, (DOACs) in light of the current coronavirus crisis. This is partially to lighten the load on the NHS and also reduce the need for you to go to a medical centre. Also, as Bob mentions, if your INR levels are unstable, your doctor might consider the DOACs to be preferential.

AF Association has created a useful booklet "Preventing AF-related stroke" which can be downloaded from heartrhythmalliance.org/afa... that might help you understand the medications and to make your decision.

If you would like a paper copy sent, please email me, [e-mail] with your address, and I will post one out later this week.

With best wishes,

Rachel - AF Association Patient Services

[Munstermum in reply to Hidden]

Thank you Rachel, I have looked through this and lots of other information all of which has been very helpful. Just wanting to find out if I was missing anything, personal feedback can be so useful. I will have to wait for feedback from haematology as I've suffered from ITP some years ago, and though now having normal platelet levels there is a risk that they could plummet again.

[Hidden]

Hello toller, lots of helpful and good advice. Considering how many millions of folk are currently taking anticoagulants, we actually get very few concerns from AF patients about any of them. DOAC’S (originally known as NOAC’s) have been around now for about 8 years and up until relatively recently, many GP’s were reluctant to prescribe them and the general view was that this was mainly due to cost issues. However, as we all know, the situation has now significantly changed!! In the early days, patients generally had two main areas of concern.

1. How do you know they work if there is no regular testing.

2. What might be the long term effects be for a medication which unlike Warfarin, has only been around for a while.

Generally, the answers revolve around testing, trials and outcomes, so by now, most of us accept they work otherwise, there would have been some kind of medically driven reaction by now. With regard to the second point, the same is probably true but most of us weigh up the advantages and benefits they offer over Warfarin and then pray!

As to which is best, that is really down to individual preference. I opted for Apixaban because although it means taking two pills a day, a reduced half life does offer some advantages. At the time, Apixaban, by a very small margin was claimed by some medics to offer a higher level of protection, but it’s all down to personal preference. Should you have any issues with the one you choose, switching is not difficult assuming to have a co-operative Doctor.......

[Munstermum in reply to Hidden]

Thank you, good points and I think my preference would be for Apixaban too.

[Hidden]

I alluded to the fact, in a recent post that this could be a concentrated effort by drug companies to remove Warfarin from the market. Regardless of side effects of NOAC's.

It is an old, old drug and very cheap with little profitability for drug companies. Just like dexamethasone.

Of course drug companies are gonna promote it anyway they can more sales = more profits. They are pedaling this via the NHS. At least one country ( Australia) has issued a health advisory on Dabigitran which to my knowledge has not been revoked.

John

[Munstermum in reply to Hidden]

Interesting thoughts....easy to forget that finances might be at play.

[CDreamer in reply to Hidden]

Facts are that despite popular conspiracy theories, the current reason for GP’s asking people to change is the difficulty in managing INR clinics in the current crisis so changing to a drug that doesn’t require monitoring if you are someone who doesn’t need to take Warfarin (eg people with mechanical heart valves).

If you add in the cost of clinic time for INR testing - is it really less expensive?

[Hidden in reply to CDreamer]

I seem to recall that NICE carried out a study factoring in these issues and I am sure Warfarin still came out cheaper. I think the study was around the time NOAC's first were marketed. Sadly, I am too busy in full time work to research this.

[northernsoul1]

I switched about 4 years ago and have never looked back. I work full time and have a busy life and have no wish to be messing about with blood tests all the time. Also can eat what I want an don't have to worry about eating too many green vegetables

[Munstermum in reply to northernsoul1]

Great to hear, I also work full time and have a family so life is busy. Not having to be at the mercy of INR testing would be a huge bonus to me.

[Hidden in reply to northernsoul1]

You just described me to perfection .... and I am on Warfarin and have been self testing for over 10 years. You forgot to mention booze, yep, I do the booze bit too. As I am over 70, I have to have an annual medical in order to retain my bus drivers licence.

[secondtry]

I read one study that favours Apixaban. I haven't started on anti-coags yet but have still not ruled out warfarin despite it not being as convenient as DOACs; the latter, as pointed out already, have a limited track record and some concerns e.g. Dabigitran in Aussie. My cardiologist said Rivaroxaban had not had a good reports in the USA, he now favours Edoxaban but that one isn't mentioned much on this Forum.

[Munstermum in reply to secondtry]

I think I read that yesterday, so I would prefer Apixaban if I were to change. Thank you.

[BobD Volunteer in reply to secondtry]

My understanding here in UK is that edoxaban is preferred by many CCGs thanks to cost implications as it is priced "competitively". Do remember that for some heart conditions DOACs are not recommended or licensed.

[secondtry in reply to BobD]

Thanks Bob, useful to know when I next talk to my Cardio/GP.

[Hidden in reply to secondtry]

Edoxaban used to be the Rolls Royce of NOACs, I had to fight to get it after the other 3 NOACs caused me side effects. I personally found it much better than the others as I did not end up in A+E throwing up blood, itchy skin, hives, brain fog or swollen ankles that the others gave me. 3 years ago it was at least double the price of rivaoxaban to the NHS

I think that Bob is right though, it is now either cheaper than the others or Doctors are getting and incentive to prescribe it

[fifitb in reply to secondtry]

What are the bad reports on Rivaroxaban, as I am on that and am now concerned.

[Alessa69 in reply to fifitb]

Have not seen the bad delete on Rivaroxaban . I was just grateful to be finally diagnosed during EaP studies for SVT & have taken it successfully for 22 months now ...... I’m often sensitive to some drugs too

[vagg50 in reply to Alessa69]

do you have to take it with diagnosis of svt?

[Alessa69 in reply to vagg50]

No. I was prescribed it after EP studies diagnosed AF

[Munstermum]

Apologies for any confusion, I've just realised that I've managed to create two accounts on different devices.

[CDreamer]

I’ve been on Apixaban now for a few years, no problems. I like it for following reasons:-

I’ve had no affects. It is a x2 daily so that means it has a shorter half life ie; clears the system more quickly. I don’t need to take with food.

Rivaroxaban- x1 daily - longer half life, needs to be taken with a full meal.

[indy64]

Seven years agoI would have suggested you to stick with warfarin. because their was no reversing agent at the time and there was a risk of severe bleeding and possible exsanguintion (drastic). Now that Andexxa is on the market, that risk has been minimized.

Like Bob, I have been on warfarin for years with minimal tweaking. I'm also fortunate that my cardiologist is about two minutes away form my house and my visits are basically once a month for my INRs unless I'm on a temporary med, like some antibiotics, that can exaggerate warfarin's efficacy.

[Buffafly]

I think there have been bad reports on Rivaroxaban in the USA. I took it to begin with but changed to Apixaban and prefer it. It works the same however you take it and I found Rivaroxaban caused ‘inappropriate’ bleeding - don’t ask unless you want TMI - also if you forget your Apixaban and remember too late you can take the next one a bit early and adjust.

[Leonardo3]

Hi I take the rivaroxaban, it’s great no need to constantly go to get blood tests and I very rarely bruise if I knock myself, I have never taken warfarin as put straight on these 2 years ago.