Posted on 09/08/2020 9:27:12 AM PDT by ConservativeMind
New atrial fibrillation drugs possess significant advantages over warfarin for reducing the risk of embolic events such as a stroke or peripheral embolism.
Patients with AFib have an especially high risk of blood clots that can lead to stroke. Warfarin (Coumadin) has been the gold standard for stroke prevention in patients with AFib for the past 50 years. But to be effective, warfarin requires careful monitoring.
Within the last several years, the FDA has approved several new anticoagulants as alternatives to warfarin: dabigatran (Pradaxa), a direct thrombin inhibitor; rivaroxaban (Xarelto), a factor Xa inhibitor; and apixaban (Eliquis), also a factor Xa inhibitor.
In testing these drugs’ efficacy against warfarin’s performance, the newer drugs showed some significant advantages. All were studied in large clinical trials of between 14,000 and 19,000 subjects—and all showed that these drugs were equal to warfarin or superior in reducing the risk of embolic events such as a stroke or peripheral embolism.
“By a significant percentage—30% to 40%—there was a reduction in stroke or systemic embolism,” Sheikh says. “And all of these drugs did it with at least equivalent safety or, in some cases, even greater safety.”
Additionally, there are dietary restrictions associated with warfarin that aren’t necessary with the new anticoagulants. Warfarin works against vitamin K, which the liver uses to make blood-clotting proteins, reducing the liver’s ability to use vitamin K to produce these proteins. So if a patient on warfarin eats too many foods with high levels of vitamin K, such as leafy greens or liver, it can affect warfarin’s metabolism. “It could either get very high or very low and increase the risk of bleeding or stroke,” Sheikh says. “But with these new drugs you don’t have to worry about these types of food interactions. People can eat what they want.”
(Excerpt) Read more at todaysgeriatricmedicine.com ...
Ping to all of you.
Something better than rat poison . . . whouda thunk???
Eliquis....................
And this is an article from 2013, so there should be other options now, too.
My buddy was on Xarelto and it worked very well. Then his insurance decided it didn’t want to pay for that anymore and forced him onto Coumadin.
Skin issues, light sensitivity, overall malaise. He even needed to see a dermatologist.
He’s still trying to get back on Xarelto. A-hole insurance...
While better for a fib there are still some conditions that require coumadin. As always talk with your doctor before making any change
Thanks for posting my husband just had a stroke about a month ago. Only clue was ability to speak got him to my cardiologist and MRI showed a stroke had occurred
Dr could not find significant risk factors artery clogs or irregular heart beat nor high BP. Put him on 325 aspirin looked at Cholesterol ( only 140) and said let’s shoot for zero cholesterol.
Put him on 40mg Crestor
We will get full results of heart monitoring in a week.
I put him on a glass of red wine daily. Glad better drugs coming forward.
The actual money quote:
“Sheikh notes that the newer drugs are expensive...”
Eliquis...you too?
;>)
Maintenance costs are lower (fewer office visits, no need for regular tab tests (INRs) and fewer risks which lead to better outcomes.
In Canada, new, higher cost anticoagulant drugs like Apixaban have to be paid for out of pocket because the state will only pay for the very cheap Warfarin which carries a much higher overhead.
“Coumadin requires careful monitoring”
Yes, you really should monitor your rat poison levels. Don’t want to lose control of that.
“Eliquis”
States on the bottle and their web site, “Not for people with artificial heart valves.”
The list price for a 30-day supply of ELIQUIS is $471
The average retail price of a 30-day supply COUMADIN is $12.53
Factor in cost of intermittent Protime/INR blood tests and Dr. visits
With my insurance I pay $50 for a 90 day supply of Eliquis. Without the insurance it would be over $1,600.
4 years ago, I was diagnosed with A/Fib, was not put on any of these drugs.
Then, we joined the big West Coast HMO, and they did a lot of tests, and I was put on apixaban (Eliquis), also a factor Xa inhibitor.
I take the drug twice a day. There are no dietary restrictions nor lab tests.
In January of last year, I had a stent installed and was kept on Eliquis, plus one baby aspirin a day and another blood thinner for a year post stent. If someone looked at me, I bruised. Then, the other blood thinner was stopped, and my bruisin basically stop.
We are on the Med. diet with a lot of green stuff and no problem.
I have been on apixaban (Eliquis) basically 3 years and no problems.
Yep, for two months after my quad by-pass................Not on it now, praise the Lord!.................
Me too
This isn’t new. I’ve been on Eliquis for a year.
I wonder what the manufacturing costs would be with and without Chinese manufactured components.
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