I finished my DSNS taper of pred on 13th March, after 20 months.
I have now set about seeing whether I should and could change my blood thinner from warfarin to one of a number of more recent NOAC drugs, which offer a number of benefits.
I noted that warfarin 'reduces the availability of vitamin K produced in the body', whereas the NOACs directly target the clotting machanism.
At a recent PMRGCAuk meetup, a member mentioned taking vitamin K supplement, as it facilitates the take up of calcium in building bones.
A lightbulb moment for me, and yet another reason to see about switching to NOACs, as I know pred can reduce bone density, and I think PMR can also?
Would anyone have any thoughts on this?
Thank's.
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hopeful-1
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Different vit K. Vit K1 is the one involved in blood clotting and vit K2 is the version helping bone building.
I am on one of the new generation anticoagulants - I trust it works! There is nothing to show it is! However, I have had no problems since I switched once some initial bruising settled down. I take Pradaxa which is 2x daily - so the effect wears off quickly if you have a need to stop (minor surgery or tests for example) and there is also an antidote if you have a bleeding episode for some reason. As far as I know none of the others have an antidote - in an accident you might require large volumes of transfused blood. For warfarin the antidote is vit K of course.
But it is very nice not having to have the INR checks every month, especially when we want to travel! I switched because the warfarin/INR suddenly went haywire and we couldn't get it under control.
I wondered whether there might be something like that! From looking at available literature online, there are 4 different drug choices, including in the UK, and in my health authority area, all now with reversal agents. I was aiming for the latest release, edoxaban (Lixiana, Savaysa), 1 tablet a day. I also had a leg op a couple of years ago, and it took an age to get the INR right, compared to stopping taking meds, have op, take meds with the NOACs.
I thought there were more with reversal agents - it was the cardiologist who claimed no. But maybe the others just aren't approved here yet. They have to ask Rome for permission to use it every year anyway!!!!
On Apixaban myself for 2 years now for atrial fibrillation. Much more convenient than Warfarin. as PMR pro said. My warfarin readings were very variable for no particular reason.
Hi, I've been on warfarin for just over eight years following a series of pulmonary embolisms that went un-diagnosed by my GP who decided to treat me for angina instead. She has retired now (Bless her) but I was left with post-thrombotic syndrome and a lung that likes to bleed when the mood takes it .
I was diagnosed with PMR last October and have tapered down from 40mg to 12.5mg. I don't find any interaction between the Warfarin and the Prednisolone neither do I find diet knocks me out of my 2-3 INR range. My general rule is eat or drink anything - even if it's on the "don't list "- the key rule being "Moderation" rather than "Binge". My usual INR test is usually a 6-8 weeks interval and usually takes the form of a thumb prick test.
As I have got a couple of "Medics" in the family I asked them about NOAC's. The feedback I got was that "They are good but they are still relatively new." vitamin k is an easy treatment for bleeding in an A&E apartment or post op situation. I'm also under a couple of consultants who take the view " If it's working why bother changing ?"
Not knowing your medical history its difficult to judge which NOAC would be best for you.
It is however safe to say that there is a higher incidence of bleeding with GI bleeds being the commonest. Rivoroxaban and Edoxoban are not recommended if renal problems are present and dabigitran is associated with Ischemic stroke. I do know someone who takes Apixaban(Eliquis) twice a day for AF with absolutely no problems..
They are all now in common use in the UK. I think it is probably a question of which best suits your needs.
Yes Andymurph, there's a lot of info on trials and recommended pathways for patients.
I've been using warfarin to prevent recurrence of DVTs I had some time ago.
Looking through comparison tables for warfarin and the 4 NOACs available on the NHS, including my area of south London, with particular interest in my particular requirements, I'm happier making a choice now rather than 5 years ago.
I'm looking forward to enjoying the benefits that advances in medication can provide, but only after I'm happy I know that I'm making the right informed choice.
This website is a real boon, helping us discuss so many things that others have experience of!
"Pradaxa® (dabigatran etexilate) 150mg bid continues to be the only NOAC, study of which showed a significant reduction of both ischaemic and haemorrhagic strokes compared to warfarin in its pivotal trial RE-LY®3,4"
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