Warfarin reduces vitamin K, which aids calcium build bone

[hopeful-1]

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.

[PMRpro Ambassador]

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.

[hopeful-1 in reply to PMRpro]

Aaah, thanks PMRpro,

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.

Thank's.

[PMRpro Ambassador in reply to hopeful-1]

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!!!!

[Hidden]

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.

[hopeful-1 in reply to Hidden]

Thank's Pepperdoggie...

[karools16]

Been on Warfarin 7 years for AF. No problems. Almost always on target.

[hopeful-1]

Thank's karools16...

[Andymurph]

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.

[hopeful-1 in reply to Andymurph]

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!

[PMRpro Ambassador]

"and dabigitran is associated with Ischemic stroke"

Not what this says:

boehringer-ingelheim.com/pr...

"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"