I have been taking warfarin since 2013 and I am now 76 years old. My warfarin monitoring shows that I am mostly within INR range set for me by the anti-coagulation team at my local hospital.
I am considering transferring to one of the new anticoagulants (DOACs , NOACs) I hesitate because I have he'd 2 life threatening gastro intestinal bleeds ( 2008 and 20140.
Do the new range of anticoagulants have as effective a reversal agent as Vitamin K is for Warfarin?
If it aint broke don't fix it is my mantra though I may reconsider when I get to 80 in 2025 as I understand Apixaban has slightly lower risks of intercranial bleeds for those over that age.
Have read the links here which support this. at 76 this is becoming more of a concern to me.
Yes - please find link to full information ncbi.nlm.nih.gov/pmc/articl....
Conventional medical wisdom has said switch to DOACs, since DOACs have proved to confer lower bleeding risks without a tradeoff in efficacy, not to mention the convenience of no dietary restrictions or monitoring, according to MedPage Today.
However, a recently published pape (see link below) is challenging that assumption in a subset of patients deemed "frail older" which is further defined in that paper.
In this subset, it seems that switching to DOAC's "ended up at elevated risk for a major or clinically relevant non-major bleeding complication..." versus Warafin.
medpagetoday.com/meetingcov...
Jim
Jim,
My GP has tried to transfer me from Warfarin to one of the NOAC's. I refused .... much along the lines of BobD's opening phrase ..... if it ain't broke, don't fix it. After nearly 14 years of Warfarin, including three medical procedures one of which was more challenging than others ( knee replacement surgery) and the fact that I self test at home with my own device, absolutely no reason to.
I have my 'official' INR test dates, but the reality is I test much more frequently at any time I like so I constantly know what my INR is at any given time. So, I am not inconvenienced in any way and don't feel the marketing blurb associated with NOAC's ( no testing issues) for me at least is invalid.
My GP has never raised the issue of switching ever again. Mind you I don't see her that often as my health is such ( so far ) that I don't need to.✌️✌️
John
My sentiments entirely after 13 years on warfarin. Stay healthy!
Thanks for this useful link.
I gather that they do but that the treatment for an internal haemorrhage rarely needs these agents as other means are used.
Apixaban or edoxaban both seem to be the favourites at present. Whether they are better for you would be a question for a doctor, I suspect, given your medical history. Bad luck on that!
Steve.
Thanks
Hi, I'd been on warfarin for about 6 yrs and found no problems, the regular checks and the staff were always v helpful and advice on stopping or reducing when having teeth out or any other health treatment. That felt reassuring.
I was put on apixaban after a heart valve repair by hospital. But I have found my arthritis is much worse, you get no checks or advice and if you start a bleed it might mean emergency hospital as it is harder to stop than warfarin. I'm not convinced that it isn't just a commercial decision by purchaser rather than medically better.
Thank you for this. One never really knows, but I'm on the cautious end re this major change. I also have a leaky heart valve, so could end u in a situation like yours. Helpful to consider this from another angle.
A few years back before there were reversal agents available for NOACs, I asked my Cardiologists what would happen with a major bleed. His reply was that if necessary you would be put on a dialysis machine !
thank goodness things have improved
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