Dr says Change Warfarin to Xarelto to prevent strokes.

[mailman-ret]

My doctor recently mentioned that I could change over from Warfarin to Xarelto to minimize my monthly blood tests. It seems that I just can't zero in on the vitamin K balance. With the negative news spread by TV, I was concerned when she offered. By scanning the net, it starts to seem as if the move isn't that risky. Is there anything that the members have encountered that would indicate that I should approach this cautiously?

[philaura]

I have been on Eliquis now for six months for A-fib. No issues, and no more testing. They do have the antidote now at major hospitals in case of an injury. I forget the name of it, but not all hospitals have access to it at this time. Guess I need to settle down a bit riding those trails on my four-wheeler.
My wife tests frequently due to a clotting disorder. She purchased her own testing machine on amazon.com and buys her test strips where she can. She tests and reports her readings to a nurse, the nurse consults the doctor, someone from the office calls her and informs her of her readings (which she already knows) and tells her what dose to take. Handy when we travel.
Phil

[Optimistic_Para]

I've been on Warfarin for many years, and only need to test once a month. My Cardiologist tried shifting me to Pradaxa. It went fine, for a while, but after about 3 months, I developed - for the first and only time in my life - insomnia. Went off the Pradaxa and back on the Warfarin and the insomnia went away, along with some muscle aches that had come on so gradually that I didn't really notice them until I no longer had them.

My cardiologist will give me enough lab orders for testing that traveling around the country and using a chain of labs like Lab Corp shouldn't be a problem. The problem will be traveling in Canada. Canadian labs will not honor a US Lab Order, only one written by a Canadian Doc. PITA!

[mailman-ret]

Thanks to all for your responses, not sure which way I will go. I spoke with the guy at the anticoagulation clinic today and he mentioned that the counteractive drug for Xarelto appears to be ready for distribution. It should be at the VA ER soon. If I should decide to go the Xarelto route, I will ensure that it is before I make the jump. He pointed out that one's diet doesn't affect your blood clotting factor if you are on it. I've never been scared of a needles, but I see that Biscuit has an understanding of my dilemma that has me looking to change. I am aware that to make the change means more tests, but once it starts working for me, tests decrease considerably. My VA doctor understanding my problem is the one that checked my other meds and advised me to make the switch, and yes it is supposedly in their pharmacy. With my disability, copay doesn't enter in to it.

[3boxerss]

I was on Warfarin for 6 months after blood clots. Was very rare due to where they were and my age... The wonderful woman at the Coumadin Clinic told me to just continue my diet. But be consistant.. To just let her know if I went a little overboard with wine, vitamin k stuff etc so she could know what or weather to adjust. What you eat this week wont show up on the test for 2 weeks..Once we got my levels steady my testing was only once a month.. I did switch from tea to coffee as the black and green tea I was drinking has alot of the K in it.. I was offered the 3 different medications and opted for the Warfarin for the reversal factor. Im clumsy and have some light headed spells so was better for me... AS others have said try one for awhile you can always change to another..

[Mortimer_Brewst]

As Old Biscuit said, Xarelto cannot be counteracted. If you are a falling risk, I would avoid it. From the experience of a family member, head wounds while on Xarelto can be very nasty.

[Old-Biscuit]

mailman-ret wrote:
Along with others on the forum, I get my medical care at the VA as I have since '92. Xarelto looks promising as after my first heart attack I realized that I am a very hard stick. I tell the lab techs that I sneak in the back door so I can catch them as they run out the door to avoid the hassle of sticking me.

I have deep veins.....have had 5 folks sticking me in attempts to hit a vein, any vein.
Current Lab Tech nails it every time. Others pass me off to her as soon as they see my name---which is fine with me!


Xarelto.......not sure it is on the VA National Formulary
If it is you have to convince your VA PCP that Warfarin isn't working or causing medical issues BEFORE they would be able to prescribe Xarelto

It is VERY expensive. Good luck with getting it thru VA Med.
https://www.pbm.va.gov/nationalformulary.asp

[Beaker]

Check the price of Xeralto or any of the alternatives and your insurance. That may stop you right there.
I am on Warafin and also reduced sodium(2000 mg per day). I have no problems with what I eat. You do need to get informed about foods containing Vitamin k which counteracts the Warafin.
You can get down to 4-6 wks between testing.

In my younger years we had an egg farm and used Warafin for rat killer. It thins their blood and they bleed to death. Of course you are not taking it at that high a dosage.

[zigzagrv]

Old-Biscuit wrote:

Until I had my ankle/foot joints fused...surgery required coming off Warfarin, transitioning to Lovenox Injections twice a day for week prior and for 2 weeks after then transitioning back to Warfarin
Stabbing myself in the belly twice a day was PITA ---not so much because of the injections but due to the bruising. Had yellow/bluish spots all over my stomach

Back to regular dosage and 6 week testing on Warfarin

With a mechanical mitral valve, this is what I have to go through for any procedure that may require surgery, including a colonoscopy. Not fun! But necessary. Learned to LIVE with it.

[mailman-ret]

Along with others on the forum, I get my medical care at the VA as I have since '92. Xarelto looks promising as after my first heart attack I realized that I am a very hard stick. I tell the lab techs that I sneak in the back door so I can catch them as they run out the door to avoid the hassle of sticking me.

[jbbrick]

Check Pradaxa, no tests, no diet restrictions but you take 2/day. A neighbor is on the Warfarin and just a touch makes a bruise. I have no side effects at all with Pradaxa, don't even know I take it.

[dieseltruckdriv]

I have been on warfarin for six and a half years, but for a valve replacement. I have made no changes to my life, but it does take some time to get the dosage figured out.
My diet hasn't changed at all, but I ate healthy before my surgery.

I like the fact that warfarin is reversible with a shot of vitamin K.

[Old-Biscuit]

For past 5 years I have been on Warfarin.....generically inclined to 'thick blood'

Took almost 3 months/testing weekly to get dosage dialed in......cause I was unaware of the affects foods high in Vitamin K affected the Warfarin

Once I became 'educated' I went to a fairly routine kind of diet and then the Warfarin dosage was steady.
Testing was then every 6 weeks

Until I had my ankle/foot joints fused...surgery required coming off Warfarin, transitioning to Lovenox Injections twice a day for week prior and for 2 weeks after then transitioning back to Warfarin
Stabbing myself in the belly twice a day was PITA ---not so much because of the injections but due to the bruising. Had yellow/bluish spots all over my stomach

Back to regular dosage and 6 week testing on Warfarin



Xarelto doesn't require that close of monitoring
Xarelto is MORE Expensive (much more!)
Xarelto can NOT be counter acted by any drug should bleeding occur


Comparisons

[wildtoad]

Is there a major financial impact with the change? I get both po’ed and suspicious when dr’s prescribe the latest drug which usually costs more than $10-20 a dose. Is the lack of testing worth it?

[zigzagrv]

Unless you change your diet drastically from week to week, adjusting your warfarin level over a monthly period shouldn't be too difficult. The warfarin dosage should be adjusted to your normal eating habits over this period of time. You should not have to alter your diet to achieve the proper PT/INR level.

If you are taking warfarin for Afib, you may switch to one of the alternative blood thinners. Some substitute blood thinners are known to cause internal bleeding problems on some patients, so make sure you are checked frequently for problems till it is determined you are not adversely affected by them.

If you have a mechanical heart valve, Xarelto and other substitute blood thinners CANNOT be used in place of warfarin.