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?
Blood thinner question: Hello. One of... - Atrial Fibrillati...
Blood thinner question
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.
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.
Cavalierrubie. Thanks so much for the reply. I'm just a bit worried about switching medications, I know it can sometimes be troublesome. I'm sure they will keep me posted if I do have to switch.
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.
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
Some CCGs will provide these on prescription.
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!
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.
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
Hi BenHall1. Thank you for the reply. That was my main concern, stopping one and starting another, If I do switch, hopefully no problems with it, except it seems getting more frequent blood tests.
gbn_ ,
As I said, apart from 4 to 6 months on Edoxaban, I've been on Warfarin since Jan 2010. There are no problems, and even frequent blood tests are no problem, maybe a food and drink diet maybe an issue for some but I doubt it. I've overcome the issues of blood tests by buying my own Coaguchek Testing device and getting my test strips on my NHS prescription. I take it with me on holiday, I've even taken it to Australia and used it there when I've travelled back home.
Using this bit of tech kit is no different to what a Diabetic has to go through when taking a finger prick blood sugar reading. I've even stopped and started Warfarin for medical procedures I've had, including knee replacement surgery. Many comments you read on this forum deriding Warfarin are quite unfounded.
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
Hi mjames1. Going to go about this asking as many questions as I can, but I'm sure going to try to stay on Xarelto if I can.
What are the limitations of Warfarin ?
BH: What are the limitations of Warafin?
I think Bob covered the main limitations of Warafin vs NOACs in his first post in this thread. Also, here is a recent NIH study which concludes:
Compared with warfarin, DOACs have more favorable efficacy and safety profiles among patients with atrial fibrillation.
pubmed.ncbi.nlm.nih.gov/349...
This doesn't mean Warafin is a bad drug for afib and some like you and Bob prefer it for I'm sure good reasons. But it does have limitations and at least here in the US, while it used to be prescribed for afib years ago, today the AC of choice are the NOACs.
Jim
Thank you ............ but I still wouldn't agree with BobD ........... Warfarin doesn't have limitations - it simply requires a different process ..... which ... is identical to a diabetic conducting a blood sugar finger prick test to get his/her current blood sugar value - mmol or whatever. Just like getting and INR value ..... can even be done in the comfort of home with the correct tech. The tech I use, coaguchek is an identical piece of kit as ued in my surgery. Definately no limitation in the use of Warfarin.
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.
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.!
Thank you pusillanimous. Was that the only reason that you changed your blood thinner?
Well the convenience of just taking the pin and not having to make frequent trips to the medical centre for tests also appealed !
Hi pusillanimous,
Yes, when I kicked off with AF in Jan 2010 my Cardiac Consultant started me on Bisoprolol and Warfarin I mentioned it to my daughter ( at that time in her career a Dental Nurse ) she commented Ooooh ! Dad, ... that's rat poison !!
How strange that it took 'Big Pharma' around 70 years, maybe more - to develop an alternative anticoagulant, the 4 in fact that we now call NOAC's.
There are so many untruths and/or distortions of the truth on this forum about Warfarin ( Coumadin ) that I can only assume those peeps are getting sponsored by Big Pharma for their comments.
Hello Ben, I don't somehow think that the pharmacist who had his own little shop in a Small South African Town/Village, was in the pay of the Big Pharma, when he referred to Warfarin as 'Rat Poison'😀
undoubtably ! nor my daughters employer either - but further up the supply chain there will be.
Hi BenHall1. Well, seems like Warfarin might be the option here if I can't get another program to help with the expense of Xarelto. As mentioned, I was just concerned about possible side effects from having to switch if I had to. As a side note though, I remember my father-in-law at the time being put on Warfarin many years ago, his leg would get so black and blue from just sitting for a while, and even the slightest bump he aquired from whatever would leave black and blue spots. I know everyone reacts differently to certain drugs, this being no exception, and it just worried me a bit.
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