Hi Everyone,
Does anyone have any experience of taking Warfarin? I’ve been on appixaban for 4 years without any issues but my hematologist would like me to switch to warfarin.
I’d really like to hear other people’s experiences, I’ve heard it’s tricky to manage and the side effects are worse. Thanks in advance.
Has your hematologist explained why the recommendation to switch from Apixaban (aka Eliquis) to Warfarin (aka Cuomidin). You are correct in what you have heard, but the answer is more complex than that.
These two medications differ significantly in their mechanisms of action, monitoring requirements, side effect profiles, and clinical use. The full comparison would require comparing these two drugs head-to-head around specific factors, including Clinical Indications, Special Populations (contraindications/cautions), Mechanism of Action, Onset of Action, Half-Life and Dosing, Side Effects, Monitoring Requirements, Diet and Drug Interactions, Reversal Agents, and Cost (Apixaban 60ea = $519, Warfarin 30ea = $10).
Given that you have been using apixaban without any issues for four years, it is very reasonable to be concerned about making a switch. It would be prudent to require a thorough explanation of why to risk a switch away from a medication that you tolerate and is effective. It would also be advisable to get a second opinion if you wish to consider the recommendation to change your treatment plan. Your treatment goals, risk tolerance, and treatment preferences are essential to making this decision. It is your prerogative to advocate to stay on apixaban if that is your preference after reviewing all of the factors involved in making the decision.
Please do let us know what you decide and how you get on.
Thank you so much for your reply, the reason for the switch is that I have some grade 2 oesophagus varices and I have been told that warfarin is reversible if I suffer a bleed so it would be the superior treatment. I am just anxious about starting anything new..
The need for a reversible medication makes sense if you are having a significant bleeding risk. That certainly makes managing your situation much more complicated. My understanding is that apixaban is reversible with Andexxa (andexanet alfa) but it is very expensive and not available everywhere. Please be sure to check out this and other options with a knowledgeable medical provider who can give you the best case-specific information. If you continue to have questions and concerns about the change, suggest getting a second opinion would be a good idea. I always do this with any significant medical decision. It is worth doing to feel more confident in the decision you end up making.
That's interesting about the treatment for reversing apixaban. When I went on it 8 years ago I was told the treatment was only available in London - not very reassuring when you live elsewhere in the UK. I'm going to ask the pharmacist when I'm next at the hospital whether this availability has been improved. It certainly concentrates the mind about taking enormous care not to cut oneself or fall. I was told that any significant knock to the head must be investigated. It's obviously must easier to use than warfarin but this is a disadvantage.
Hi Darcy,
I’ve been on Warfarin for many years due to a mechanical heart valve that can engender clots- hence, the need for a daily anticoagulant.
It is difficult to manage at first until you establish *your normal* range, typically (but not always) in the 2.5-3.0 range. It will require frequent lab tests , colloquially referred to as “INR’s”; less so once/if your physician instructs you to undergo them less frequently.
Diet is critical. As the nurses who manage my INR numbers are fond of saying, “almost everything affects warfarin levels” especially green vegetables containing vitamin K. Check with your dietitian; it’s important to know how and why certain foods can affect your levels.
Is the physician that you refer to a hematologist? If not, a consultation may well be in order. Last, there are now drugs that are anticoagulants not requiring such monitoring, “Elloquis” is but one example.
For your privacy, I’ve not inquired as to your diagnosis and/or your physician’s reasoning. I am here in the U.S. where the newer anticoagulants are available, if medically indicated. Prior authorization is generally required as the newer drugs are expensive
Best of luck. I hope this helps and you’re welcome to send questions/concerns my way. Be well.
Thank you so much for your reply, I’m sorry to hear you have been on warfarin for so long and thank you for sharing your experience with me. I have oesophagus varices and I’ve been told that warfarin can be reversed if they bleed so it is the safer option. It’s good to hear your experience, I would prefer to stay on appixiban but I think I will most likely make the switch. Thanks
I've been on warfarin since 2013. A bit of a steep learning curve to start with regarding diet but soon stabilised. I am self monitoring and have my own coaguchek machine so can do my own blood tests at home. My brother in law has been on warfarin for 50 years and was in the first UK cohort to self monitor.
Any green leaf veg will affect INR and cranberries have a massive effect. There are other diet and drug interactions.
Warfarin is a very old drug and well understood. I do well on warfarin and less well on the newer drugs with less side effects but we are all different. Good luck.
from what I understand from a friend who is on apixaban, when he had a fall ambulance took him to hospital as they had to watch him till the apixaban wore off (12 hours i believe after taking pill) to make sure he didn’t have a bleed where he hit his head. Not sure what they would do if he had been on warfarin. Guess they would have still taken him to hospital but could have reversed it as you said and therefore wait wouldn’t be as long. Mind you, you could be waiting 12 hours either way for ambulance or hospital to attend these days😼😸. My brother was on warfarin for a while and needed to have several blood tests each week till it was balanced. Alcohol affects warfarin a lot as well as some foods. I am sure you will got lots of useful advice on this site
I’ve been on warfarin 18 years. Only problem I have is it can take adjustment to get dose right. I have liver problems and as the liver processes warfarin can find it is impacted. I wouldn’t be without my coaguchek self monitor - removes the need for hospital visits. Having had bleeding varices and a brain bleed can definitely see the benefit of reversable blood thinner. I’m allergic to heparin and have had fondaparinux as bridging treatment which I am told there is no drug to reverse.
I have had no side effects from warfarin and I am on a high INR (3.5-4). I have PV treated with Ruxolotinib.
If you’re uk based ask them to agree to fund strips for self check meter if you’re going down that route (you have to pay for meter)
Good luck whatever you do
Hi. I was on Warfarin for awhile but had difficulty keeping my INR in the right range. And when it dropped low I developed blood clots quickly. Because of this my doctor switched me to Eliquis which I find much easier. There’s no testing your INR or worrying about what you eat or developing blood clots. Good luck. Katie
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