Blood thinner question

[gbn_]

Hello. One of my afib medications is Xarelto, 20 mgs. I was put on a program from when I was in the hospital last November for afib to help me with the cost of the medication, the program was good for a full year. I just called in my refill for my meds, for the next 90 days. That will take me into November, and my year of Xarelto help will be expired. I could call Xarelto to check on any other programs, or try other programs with the hospital, but usually everything is regulated with yearly income, and I am just barely over the income limit for help. I could still try, or go to something else. I called the nurses station where my cardiologist is, and they called back mentioning this option if all else fails. Question is, is it dangerous to switch from one blood thinner to another like this? The nurse mentioned Warfin, which is very cheap in price. Would I have to have a "washout period" before switching? Very concerned about this. Any other do's or dont's with switching if I have to do it? Is there anything else out there besides Warfin that is inexpensive?

[BobD Volunteer]

Warfarin does have some limitations in that one needs regular INR testing to ensure that your clotting factor is correct. DOACs such as Xarelto to not need this regular testing so whilst the drug may be cheaper the overall cost to you in USA may not.

I have been on warfarin for over twenty years (long before these newer drugs became available), have my own testing machine with test strips provided by our wonderful National Health Service here in UK and a very stable INR so perhaps lucky in that respect.

[Cavalierrubie]

Your warfarin nurse should guide you through the transition, which many people have done and l don’t think it is a big deal. I am on warfarin and it is a very safe, tried and tested drug and used for many years. The medics are very experienced in the use of it. I am intolerant to the new anticoagulants and so l am thankful that warfarin is around. I don’t know about cost as l am in UK but again, ask a pharmacist.

[Buffafly]

I see in the news today that the cost of Xarelto and Eliquis is going to come down but I don’t know if that will help you. We mostly get the generic versions - Rivaroxaban and Apixaban, which don’t seem to be available in the States for some reason (profit?). I have heard of people importing those personally to save money.

[Bagrat]

Agree with Bob good tried and tested drug warfarin and once you get onto a stable dose, like my husband, blood tests may drop to every 10 weeks. However,may take a while and there may be hiccups when tests need to be more frequent.

Having your own machine in UK is for convenience but you need a doctor or clinic nurse who will partner you in this. The test straps are dear even here

[BobD Volunteer in reply to Bagrat]

Some CCGs will provide these on prescription.

[Bagrat in reply to BobD]

Thank you. Dear husband likes his trips to surgery as clinic nurse is forward thinking , unlike the coaguchek algorithms which only work on what has already happened!!! Or maybe she's intuitive!

[BobD Volunteer in reply to Bagrat]

The computer system is not fit for purpose so I have to lie to the phlebotomist what I am taking. It does not recognise rising or falling trends so if you go 2.4, 2.3, 2,.2 etc it will let you fall off the end or likewise the other way. I adjust my own dose according to my experience and am now on 56 day cycle and not been out of range in the last year since my new book started. One of my sons' O H is senior practise nurse at a different surgery and laughs when I tell her.

[Bagrat in reply to BobD]

😂😂Fortunately our clinic nurse although now a care assistant was a nurse and can guide the GPs to ignore the computer when needs be. It's the Ways and Means act at its best.

[BenHall1]

Hi,

Like Bob, I've been on Warfarin for ages, since Jan 2010 ( 14 years). I self test with my own Coaguchek device supported by my Doctors surgery and my INR Clinic Nurse. Test strips are provided through the NHS. This process incidently ( in case you get misinformed ) is identical to the process a diabetic goes through when performing a blood sugar finger prick test.

I spent 14 years on Warfarin and when I got allocated a new GP who is young and very well educated in the range of 4 NOAC's .......... she tried for ages to get me off Warfarin and I refused. In the end I agreed to try Edoxaban and did this for 4 to 6 months and gave it up due to unwelcome side effects ( vile and violent nightmares ). I told my GP I would never take any of these NOAC's ever and I will go back to Warfarin. So, in April 2024 I returned to Warfarin ........ happily, back to self testing ..... and I'm as happy as a pig in a mud bath.

Absolutely no problems ....... I might add - in favour of Warfarin, the 14 years from Jan 2010 I continued my long established career driving buses. No problem with either my employer or my drivers licensing authority. Further, I've also had three medical/surgical procedures including knee replacement surgery when I've had to stop and restart Warfarin .... all done without any problems/issues - at that time I was 71 .... I turn 80 in Sept 2024. I might add that when I switched to and from Edoxaban I was told to stop one and restart the other without any 'Washout' period as you refer to it. Stopped one and started the other and the reverse when I returned to Warfarin and having my own testing device made it sooooo easy ... I simply controlled my own destiny. Sorted.

Good luck with your decision making.

John

[mjames1]

I would look for another NOAC and hopefully you will get a better price. There are several. NOAC's are interchangeable. Warafin is an older drug with limitations and unless you have a good reason to use Warafin, I would stick with a NOAC.

Jim

[secondtry]

My UK cardiologist told me last month that Apixaban (maybe differently branded in US) has just come off patent and is now the cheapest in UK.

[pusillanimous]

When I was first diagnosed with AF, the Cardiologist I saw prescribed Warfarin because that was his formula for AF, Bisoprolol and Warfarin. I was not keen on it, rightly or wrongly my pharmacist kept referring to it as 'Rat Poison', so I asked my GP to change me to Xarelto. If I recall., the transition was easy, it was pretty much taking the last pill one day and the new one the next, I'm sure it must be the other way round too - that was 5 years ago.!