Recently my EP suggested that maybe I would prefer to be taking NOACs rather than my current anticoagulant Warfarin as it would reduce blood tests.
On his recommendation I had a consultation with my GP to discuss this option.
I have had 2 occasions in the past 6 years where I have had a serious bleed (cut artery in hand and uncontrollable nose bleed). On each occasion I was given an infusion of Vitamin K to reverse the anticoagulant effect of the Warfarin.
Because of this I asked my GP what would be the procedure if I had another serious bleed having changed to NOACs. He told me that they would give a plasma infusion instead of Vitamin K but that it would be a very similar procedure.
My GP reminded me that my INR control on Warfarin had been very good over the past 15 years and that I was only having 3 monthly blood tests.
My GP said that if I changed to NOACs I would still have to have a kidney function blood test every six months thus only reducing my frequency of blood tests from 4 to 2.
My GP said he had no objections to me changing but it was my decision.
All things considered I took the “if it ain’t broke don’t fix it” view and am going to continue with Warfarin.
I certainly understand more now.
Pete
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pottypete1
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I am one of those fortunates who, having been on Warfarin for nearly 14 years, has had no problem. My GP has suggested I move onto NOAC's and I explained to her that as I self test, working in conjunction with my INR clinic, and have a stable INR - always in the range of 2.2 to 2.7 why should I change .......... your philosophy " if it ain't broke, don't fix it " ! I am currently on 8 weekly tests. I am 79 in a week or so. Unless I inflict some mischief on myself ( DIY ) I am not a bleeder. For me the key is to self test.
Another take on this is ......... for many folk, who were unable to handle Warfarin the NOAC's were a gift from Olympus. however, since they have become more widely used they too have presented users with side effects that have been both unwelcome and not anticipated. Some NOAC's more so than others.
So, for me, basically ... yer pays yer money and takes yer choice. No way would I come off Warfarin. I might add that I have had 3 medical procedures that have involved me in stopping Warfarin and then restarting again, either directly with Warfarin or initially a bridging anticoagulant, then back onto Warfarin dose. The most challenging was knee replacement surgery.
I have no experience of either warfarin or doacs, but as I have been recommended Apixaban, I have more than a casual interest in this question.
But I have to acknowledge that warfarin has a reassuringly long history of safe use as an anticoagulant. Comparatively the history of doac use is worryingly short, and some Forum members do report unwelcome side-effects.
However, all of the recent research I have read indicates lower risks of strokes and brain bleeds with the doacs over warfarin. This could well be decisive in any decision making, but more research is needed into the possible biases involved in producing such results. Could it be that the warfarin users selected to produce these comparative results are simply an older cohort than the younger doac users being added each day as AF increases. More work in this area and ongoing monitoring of doacs is needed before I will be convinced of their superiority. If only we had such time!
I forgot to add a typical article about the "superiority" of doacs ...
Just another take on this .......... I went onto Warfarin at age 65, I turn 79 shortly, I drive buses part time (30 hrs a week ) to keep myself young ( passengers are College students ) and so I regard myself in a high risk group compared to many 79'ers in that if I'm involved in a road traffic accident I could be in a deep mess - equally though I do alot of private motoring, long distance and run the same risk. Point is its up to the individual to behave responsibly when taking these sort of meds and don't put themselves in harms way ( deliberately or accidentally ) as much as possible. I'm a Warfarin for lifer !
Hi, I'm on apixaban used to be on warfarin. My experience is apixaban makes arthritis pain and joint stiffness worse. I found the INR checks reassuring, and INR staff able to advise before any medical/dental procedure with apixaban I haven't the foggiest idea of my INR. Apixaban harder to reverse if a bad bleed.
Very interesting. As we are all aware there are side effects to every tablet we take, the only trouble is that we are all so different and therefore what might be right for one person is definitely not right for another.
I suffer from Arthritis and it is bad enough without a change of drug potentially making it worse.
I don't think I agree with your warning about a "bad bleed"(?). 🤔
I was recommended Apixaban by haematology in 2021 after suffering unexplained chronic bilateral subdural haematomas in late 2016, and have read it is prescribed even after strokes for patients who need anticoagulation.
If you read the research, reversal agents are available for Apixaban that start to work within minutes.
I severed my artery in my hand and it took about 3 hours with a torque off and on and also Vitamin K. They ultimately strapped a bottle in my hand to put pressure on the wound so that I could be transferred to another hospital safely where they carried out a 3 hour microsurgery operation
The next time back in January this year I had a nose bleed that lasted hours and they gave me a Tranexamic Acid infusion plus a rhino plug up my nose. 2 days later they cortirised the blood vessels in my nose.
Both occasions it was very frightening but as you can tell I am here to tell the tale.
Both options of anticoagulant have their draw backs and it is really a matter of what is the correct one for each person.
The article referenced by Coco51 in this Post is worth reading re reversal agents, with the following conclusion mentioning the 2 minutes I quoted from that article ...
"Andexanet alfa is the first FDA-approved agent for the reversal of anticoagulation in patients treated with apixaban or rivaroxaban. This agent dramatically decreases the anti-factor Xa activity within two minutes of administration and it has received an accelerated approval from the FDA. Despite its relatively high cost, andexanet alfa has shown promising results and potential in managing life-threatening bleeds for patients who are taking DOACs".
I suggest research on Google needs to be assessed for its timeliness as negative opinions can change quickly with new research, and vice versa of course.
NICE will decide whether to review the evidence when the results from the randomised controlled trial of andexanet alfa compared with standard care in intracranial haemorrhage are available. The results are anticipated in 2025.
So Nice has approved this reversal agent since 2021, and the USA since 2019, but a review is expected in 2025. Not sure that info needs to be highlighted as a problem. Unless I'm still missing something?
I think the warfarin and NOAC groups in the trials were similar. However, the INR control for warfarin patients was woeful (e.g. only 62% for the apixaban trial) which is why warfarin came out worse than the DOACs. Nice consider less than 70% to be poor control. At 70%, warfarin is equivalent to the DOACs, and at 75% and above is actually better!
I was put on Rivaroxaban 20mg in January last. By the end of Jan, I had truly dreadful digestive problems. The cardiologist changed the DOAC to apixaban 5mg BD, but this made no difference. I am getting typically 3 hours sleep per night.
The current plan is to change the anticoagulant to warfarin. On the basis that it works differently to any of the DOACs. it might make a difference. Not very scientific, but I wonder if anyone has had any similar experience with DOACs
Yes, me. I cannot take any of the new drugs as they made me very sick physically and mentally. Warfarin is the only anticoagulant l can tolerate. Best wishes
Following an unusual series of events, I had a punctured intercostal artery while on apixaban. It was managed by A&E using blood plasma. Afterwards, the consultant told me that managing a bleed for a patient on a DOAC is standard procedure in any hospital and they don't need a reversal agent (which does exist) except in very rare circumstances. There is no reason to fear 'bleeding out' under normal circumstances while taking a DOAC.
My kidney function is tested annually - just saying.
I don’t get a six monthly test either. My dentist changed recently and I mentioned that I was on an anticoagulant - so he asked which one. I said Apixaban and his reaction was ‘good, that’s the best’.
Well, my GP said Warfarin was the best, so who is correct? Do they really know? Apixaban has not been around as long as Warfarin and the medical profession are experienced more with Warfarin.
I had a really bad fall and crashed my head last year causing a brain haemorrhage. It was a simple procedure of a reversal drip through a cannula and not take my apixaban for a week
I completely understand your decision. If you get on with Warfarin and, importantly, trust it, why change. Importantly you are stable on it. What's not to like? However I thought you might like to know my reasons for taking another choice to change to Apixaban. Firstly there IS now a specific reversal agent for Apixaban called Adexenet (link below) which starts to work after a few minutes. More quickly than a vitamin K infusion for warfarin. There are also other less specific agents like Tranexamic Acid.
I spoke to my GP and we went through both options. asked about varying INR levels on Warfarin caused by various food and drugs. His answer surprised me. He said acceptable levels of anti-coagulation on Warfarin were that the patient was in range 60% of the time. To me that sounded rather low. It undermined my trust in it somewhat.
I did not like warfarin, nor the tests nor the uncertainty of my INR levels between the tests which started every week then became 12 weekly. Nor did I want to do home testing.
My cardiologist and EP were very much in favour of Apixaban. The GP was not, simply because of the cost. He couldn't name any occasion in his experience where a patient had had more clinical problems with one or the other.
The fact that Warfarin has been around for a long time is certainly an argument in its favour, but for me it doesn't always apply. For example, at first very long time ago I was given daily Aspirin for AF, but it gave me terrible gastritis and a threatened stomach ulcer and I had to stop. I am often the exception to the rule!
So I plumped for Apixaban and have a blood test every year (not 6 monthly).
I don't advocate my choice for everyone
We can only ever opt for one or the other and hope we did the right thing! There are large numbers of articles supporting both choices. Yours is right for you.
Anyway, onward and upward! here's the link on Adexenet.
If a bleed was that serious, on warfarin you would be put on Prothrombin complex concentrate (PCC) which reverses warfarin within 10 mins and is vastly cheaper than Adexanet Alfa (so you are a lot more likely to get it!)
Have had 2 very serious bleeding incidents on Warfarin and as the doctors at my hospital sorting me out it would seem that Vitamin K or Tranexamic Acid infusion worked for me.
I do not feel qualified to research options and feel I had a full discussion with my GO on the matter.
I feel that I do not want to change anticoagulants. I have been stable with my current medication regime for 6 years now.
This is a discussion forum and as I have observed so many times, rather like politics there always seems to be opposing views held very strongly by people on nearly every subject.
I absolutely agree and don't doubt for a minute it's right for you and multitudes of others here. It's good we have a choice and a say in these decisions! Best wishes ❤️
I was on warfarin for AF before the pandemic and didn't suffer any ill effects apart from red water in the toilet pan when I first started it. Nothing was wrong though so I continued with it albeit reluctantly knowing it was basically rat poison. My EP cardiologist said warfarin had been around for years and they knew a lot about it and it was reversible should I have an accident. However, when the pandemic struck, my GP suggested I change to Rivaroxaban as this would negate the need to visit the surgery for INR tests and therefore be safer for me as I am at high risk due to the AF. I checked with my cardiologist and he said it was a good idea so, again reluctantly, I changed to Rivaroxaban. I needn't have worried as I have suffered no ill effects and when I had my ablation in August, I only had to stop it for 1 day rather than the 5 days for Warfarin for any procedure or operation
Interesting to hear, Pete. If I were you I’d definitely stick with what I know and is working for me. The fact that warfarin has been around longer, and can be proven to be anticoagulating (is that a word?!) your blood, is a big plus in its favour, in my opinion.
I was put straight onto DOACs (rivaroxaban, then switched to Apixaban) when I was diagnosed with AF in 2016. If I knew what I knew now, I think I’d have asked to try warfarin first to see if I got on with it. I suspect I’d be one of these people whose INR levels are too changeable and unmanageable (as I have lots of sensitivies to foods and meds) but if I could have got it reliably in range I think I’d find it more reassuring than just having to trust my DOAC is doing its job. I wish there was an equivalent of the INR test for DOACs!
Glad your GP was willing to talk about it and help you make your decision Jx
Hi Pete, hope all is well. I changed from Warfarin to Apixaban back in 2016 and have no regrets. I had no problems with Warfarin and whilst at home, my INR remained stable because our diet was fairly consistent. However, we travelled abroad a lot and particularly on one occasion my INR was too high probably due to the changes in eating habits whilst away. I have to say that Apixaban made things a lot easier with far less to worry about regarding medication and physiologically AF seemed to become less of a problem. However, like you, I’m a great believer in if it ain’t broke, don’t mend it so for you, you probably have made the right decision.
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Jx 
Unable to take anticoagulants, update
Looking for an alternative to Warfarin. Vitamin E therapy? 
NOACS
